Jobeth asks:
I have left-sided ulcerative colitis. When I have flare ups, I notice that the left side of my abdomen is tender. Over the last couple of months, my mid-abdomen has become really tender and feels. It seems to get worse as my period approaches, and gets a little better as it ends and for about a week afterwards. My menstrual cycles have become increasingly shorter, as well. Should I see my gastroenterologist or my gynecologist?

Anil Rustgi, MD responds:
Ulcerative colitis is an inflammatory bowel disease that affects the rectum and large intestine. There are several different types of ulcerative colitis, which are classified by the extent of the inflammation and its location. Left-sided ulcerative colitis is characterized by inflammation beginning in the rectum and extending up the left colon, causing diarrhea, abdominal cramps, abdominal pain and weight loss.

Left-sided Ulcerative Colitis

There are other types of ulcerative colitis that affect larger areas of the colon and could cause pain or tenderness over the mid-abdomen. I recommend first seeing your gastroenterologist, so he or she can determine whether or not your symptoms are related to the ulcerative colitis.

Mark Osterman, MD, MSCE is a Penn gastroenterologist who specializes in inflammatory bowel disease. He can evaluate your symptoms and recommend the best course of action. To schedule an appointment, please call 800-789-PENN (7366) or request an appointment online.

Steve asks:
I am 52 years old and was diagnosed with left sided ulcerative colitis in February, 2007. I believe I may have contracted a germ or been exposed to a bacteria in October of 2006—under unusual circumstances too long to explain here—that may have caused my colitis, though I have been told that there is no known cause of ulcerative colitis. I was initially on Asacol® for a number of months and then switched to Lialda™ (4.8g per day; later changed to 2.4g per day). For the most part, my colitis has been in remission.

In April, I had a colonoscopy and was told by my gastroenterologist that he removed two small polyps. I should also note that about one and a half yrs prior to my colitis diagnosis, I was diagnosed with type 2 diabetes, for which I have been on Metformin. Over the last number of weeks, I have had two bouts of constipation and diarrhea. Prior to the second diarrhea bowel movement, while I was having constipation, my gastroenterologist told me to take MiraLax®.

Following the second diarrhea bowel movement, I had a bowel movement of small thin stools. When I told this to my gastroenterologist, he told me to take Citrucel® for five to seven days to add bulk to my stool. I am now in day three and though I do not have constipation or diarrhea, my stool is still very thin. Also, I sometimes have to go back to the bathroom in a short time to complete my bowel movement.

Is it possible that another polyp or obstruction could have developed since my last colonoscopy six months ago? Could I now have colon cancer? I have had faint discomfort in the left lower quadrant of my abdomen the last few days along with these thin bowel movements, in addition to very slight nausea.

Can colitis turn to cancer in less then two years? If in fact, it was bacteria in the environment that may have caused my colitis, could that precipitate my colitis turning into cancer at a faster rate than expected compared to the average case of ulcerative colitis? Should I request that my doctor perform a colonoscopy now – six months since my last one – rather than waiting until one year has elapsed?

Anil Rustgi, MD responds:
Ulcerative colitis is an inflammatory bowel disease that affects the rectum and large intestine. What causes ulcerative colitis is still unknown, but attacks can be brought on by a variety of things, including physical stress or respiratory infections. Colon polyps are growths of tissue that develop. They vary in size and shape and if they are not removed, there is a higher risk of colon cancer.

Since your doctor removed your polyps just six months ago, it is unlikely that additional polyps have developed because they take around five years to reach one half inch, and it takes another five to ten years to develop into cancer. Since you do suffer from ulcerative colitis, you have a higher chance of colon cancer developing – depending on the severity of your case.

However, since you have a very involved case, I recommend you see Mark Osterman, MD, MSCE. Dr. Osterman specializes in inflammatory bowel disease. He can evaluate your condition and recommend the best course of treatment. To schedule an appointment, please call 800.789.PENN (7366) or request an appointment online.

Reece asks:
I was diagnosed with ulcerative colitis two years ago. I've been taking Asacol® ever since. A recent colonoscopy showed that it has spread to the entire colon. Are there medical options that would have prevented this?

Anil Rustgi, MD responds:
Ulcerative colitis is a type of inflammatory bowel disease that affects the large intestine and rectum. The disease usually begins in the rectal area and may eventually extend through the entire large intestine. Treatment options consist of medication to control acute attacks and help the colon heal, and surgical removal of the colon.

Asacol® is a brand name mesalamine medication – an anti-inflammatory drug used to prevent swelling or wearing away of the colon's lining. It works by stopping the body from producing a certain substance that may cause pain or inflammation. The only absolute cure for ulcerative colitis is surgical removal of the colon.

Mark Osterman, MD, MSCE is a Penn gastroenterologist who specializes in inflammatory bowel disease. He can evaluate your condition and recommend the best course of treatment. To schedule an appointment with Dr. Osterman, please call 800-789-PENN (7366) or request an appointment online.

L asks:
My husband has been diagnosed with ulcerative colitis and his current course of treatment is the steroid prednisone and Lialda™. While we understand this is the common course of drug treatment, is there a vitamin and diet approach that would also relieve symptoms?

Anil Rustgi, MD responds:
Ulcerative colitis is a type of inflammatory bowel disease that affects the large intestine and rectum. The disease usually begins in the rectal area and may eventually extend through the entire large intestine. Diarrhea, abdominal pain and weight loss vary in severity and may start gradually or suddenly. The cause of ulcerative colitis is unknown, but risk factors include a family history of the disease.

Treatment options consist of medication to control acute attacks and help the colon heal, and surgical removal of the colon. Although ulcerative colitis is not caused by diet, watching what you eat can help reduce symptoms and promote healing. Patients should maintain good nutrition and can often eat a reasonably unrestricted diet.

A low-roughage diet is often suggested for those prone to diarrhea after meals. Patients appearing to be lactose intolerant should avoid milk products. In addition, taking a multivitamin regularly may be recommended. However, each patient is different and your gastroenterologist is the best person to advise your husband about his care.

Mark Osterman, MD, MSCE is a Penn gastroenterologist who specializes in inflammatory bowel disease. To schedule an appointment with Dr. Osterman, please call 800.789.PENN (7366) or request an appointment online.

NormaJean asks:
In May of 2007, I had a biopsy showing severe blunting of the villi in my small intestine. I was diagnosed with celiac disease. I had a double-balloon endoscopy (DBE) done in January for bleeding due to arteriovenous malformations (AVM) — seven areas were cauterized.

After the DBE, I had chronic diarrhea for 30 days. Prednisone was prescribed - starting with 40 mg for seven days and reducing the dosage by 5 mg each day afterwards. I was fine for three weeks and then the diarrhea returned. I started taking prednisone again, this time starting with 20 mg. I am down to 10 mg now. I am also on a gluten-free diet.

My GI doctor said I might have Crohn's disease instead of celiac disease. My blood tests for celiac disease have always been normal. I am going to have a Prometheus IBD test done. What is this? What is the treatment for Crohn's disease? If I have Crohn's, can I assume that I do not have celiac disease?

Anil Rustgi, MD responds:
The PROMETHEUS® IBD Serology 7 is a blood test that helps your physician determine if you have inflammatory bowel disease (IBD), and if so, which type – ulcerative colitis or Crohn's disease.

Crohn's disease is treated with a combination of medications and may eventually require bowel surgery. Crohn's disease is not directly related to celiac disease – it is possible to have both.

To make an appointment with a Penn gastroenterologist specializing in celiac disease and Crohn's disease, please call 800.789.PENN (7366) or request an appointment online.

MommyPop asks:
I've suffered with Crohn's disease for 23 years and have had a colostomy for 12 years. I would like to see a Penn doctor that specializes in Crohn's disease and colostomy.

Anil Rustgi, MD responds:
Faten Aberra, MD, is a Penn gastroenterologist who specializes in Crohn's disease. To schedule an appointment with Dr. Aberra, please call 800.789.PENN (7366) or you can also request an appointment online.