Ask the Doctor

At the Section of Colon & Rectal Surgery, we respect our patients and encourage them to ask questions. Below are answers to some of the most frequently asked questions.

Are there any foods a person with an ileostomy should avoid?
A patient with an ileostomy can mostly eat a regular diet. However, some foods are especially prone to blocking up an ileostomy, including:

  • fresh peanuts (in the shell)
  • brussel sprouts, broccoli, cauliflower
  • any raw vegetable that is eaten without chewing well.

These types of foods can cause what is known as a "bolus" obstruction. This means that a large mass of vegetable matter is clogged directly behind the ileostomy, beneath the abdominal wall. If such a blockage happens, patients can usually drink cranberry juice or stay on liquids to get the matter to pass out of the body. In some cases, an enterostomal therapist (ET) may have to pass a small rubber tube through the ileostomy and rinse it out with water to help dissolve the blockage.

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Is prednisone safe to take during pregnancy?
Prednisone is generally considered to be safe during pregnancy. The number of stillbirths and low weight babies is, however, slightly increased in some patients who have other types of disorders (i.e., connective tissue disorders) who are treated with prednisone.

The American Academy of Pediatrics does not consider prednisone to be a contraindication to breastfeeding. It is best to ask your personal obstetrician and gastroenterologist about the safety of this drug before planning pregnancy or before taking any medicines while pregnant.

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What is the difference between a colonoscopy and a flexible sigmoidoscopy?
Both tests examine the inside lining of the colon and rectum using a lighted instrument. Biopsies can be performed using either technique. The flexible sigmoidoscopy uses a relatively short scope to view the lining of the rectum and the lower portion of the colon.

A colonoscopy has the capability of examining the entire lining of the rectum and colon. In most cases, it can even be used to examine the lining of the terminal ileum-which is the end part of the small bowel. This can be particularly important for patients with Crohn's disease, since the terminal ileum is a very common location for Crohn's disease. In addition, during colonoscopy, polyps (growths) can be removed. Colonoscopy is considered the most accurate method for colon cancer screening and for examining the entire colon and rectum.

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Is it harder for women with inflammatory bowel disease to get pregnant?
Not in most cases, but it you are feeling ill, you may have a lowered sex drive. Crohn's disease more frequently involves the terminal ileum, which is next to the right ovary and tube. If there is a lot of inflammation in this area, you might have scar tissue around your tube. In some such cases, invitro-fertilization may be necessary.

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I have been on prednisone for over a year, should I be taking calcium supplements because of this?
Yes, you should be taking calcium supplements. One of the easiest ways to do this is by taking Tums.

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About how often should ulcerative colitis patients undergo colonoscopy?
After you have been diagnosed as having ulcerative colitis for eight years, we recommend that you have a colonoscopy every year, with random biopsies to look for dysplasia—abnormal changes in cells that may lead to cancer. Surveillance via colonoscopy is generally followed for patients with left-sided colitis or pancolitis—meaning colitis that affects the entire colon—vs. people with colitis limited to the rectum, for which regular colonoscopy screenings are usually not necessary.

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What is the difference between brand name and generic drugs?
Both brand name and generic drugs have the same ingredients, but the generic is less expensive. The Food and Drug Administration's ruling is that manufacturers must supply a drug dose that will result in 80% to 125% of the maximum generic drug concentration of the brand name drug. This variation usually makes little difference, except in cases where dosing must be exact, as with certain heart medications.

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I am 28 and newly diagnosed with Crohn's disease. I've heard that most people with IBD have a family history of it. However, I've found I have no relatives with either disease. Is this common?
A family history of IBD tends to be stronger for children who are diagnosed with it. Roughly 25% of children with Crohn's disease or ulcerative colitis have another family member with the illness. Adults who are diagnosed with Crohn's disease or ulcerative colitis are less likely to have a strong family history of it. However, if they have a family member with IBD, then they are at a slightly higher risk of getting it than the general population.

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Can a person develop colon cancer before age 50?
Yes, the number of patients developing colorectal cancer under the age of 40 is increasing—some of these without any apparent risk factors, such as a family history. You should be screened, regardless of age, if you have bleeding or experience a change in bowel habits, such as constipation or diarrhea.

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When is a diagnosis of irritable bowel syndrome (IBS) made?
IBS is always a diagnosis of exclusion. For example, if a patient comes into the office with complaints of abdominal cramping, tests must be done to check for more serious gastrointestinal disorders such as colorectal cancer, ulcerative colitis, or Crohn's disease, among others. If the results of all screenings are negative, then a diagnosis of irritable bowel syndrome is made.

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What is microarray technology and how is it helping researchers?
Former research fellow Nigel Crawford, MD, replies:

Our genes determine everything from our physical traits to diseases. Microarray technology is helping researchers better understand how our genes work.

Microarrays are small glass slides with DNA placed on them. The DNA on these microarrays represent many thousands of human genes. We use microarrays to determine which genes in the colon are turned on or off and to what degree a gene is turned on or "expressed." The degree of "light" in specific tissues or cells is what we call gene expression levels. The technology gives researchers the "big picture" by allowing them to look at thousands of genes in one experiment.

Microarray Slide

For example, researchers in our laboratory extract genetic material from colonic inflammatory bowel disease or cancerous tissues. This material is then labeled with a fluorescent dye, mixed with the DNA on the chip, and scanned by a microscope that resembles a computer scanner. The brighter each gene lights up, the more the gene is turned on in the tissue being studied. The darker dots are genes that are either turned off or expressed to a lesser degree.

By comparing gene expression levels between different tissues, we hope we may one day be able to determine which genes are responsible for causing specific forms of colonic inflammatory bowel disease such as Crohn's colitis.

Image courtesy of Affymetrix. Affymetrix® and Genechip® are U.S. registered trademarks used by Affymetrix, Inc. (Santa Clara, CA).

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What are Laser Capture Microdissection (LCM) and microarray technology and how will they help in the diagnosis and treatment of IBD-associated colorectal cancer?
Former Research fellow Suhal Samad Mahid, MBBS, MRCS, PhD, responds:

We know that having IBD poses a risk for the development of colorectal cancer—particularly in people with ulcerative colitis (UC). In our laboratory, we are searching for the genes involved in the development of UC-related colorectal cancer by combining the latest LCM and microarray technology.

Using thousands of pulses of laser, LCM technology allows researchers to "capture" or select only the cancerous cells from colonic tissue samples for comparison to non-cancerous colonic tissue.

Microarrays or "gene chips" help us analyze gene expression levels—which genes are turned on or turned off in the colon—by generating a genetic profile or picture.

Identification of these cancer-causing genes could lead to exciting breakthroughs in the diagnosis and treatment of this important complication of IBD.

In the future, physicians might send routine colonoscopic biopsies for laboratory testing to see if these cancer pre-disposing genes are starting to be "switched on." Doctors could then recommend medication, if available, to help lower your cancer risk or, if you are at particularly high risk, surgery to remove the colon.

Ultimately, this technology could also mean a simple blood test to screen for UC-associated colorectal cancer.

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