Patient's Query
Hello doctor,
I am 35 and have had ulcerative colitis for four years. My colonoscopy report last week showed mild rectosigmoid inflammation, and my CRP was 16. I am on Mesalamine and Azathioprine, but still have four to five loose stools daily with blood streaks.
When do you usually recommend starting biologics like Infliximab? Are they effective long-term or only for severe cases? Can stress or certain foods actually worsen flare-ups? I have been avoiding milk and spicy food. Is that really helpful or just a common belief?
Please help.
Thank you.
Hello,
Welcome to icliniq.com.
I understand your concern.
I can understand how exhausting it must be to deal with ongoing symptoms even while staying consistent with your medications. In ulcerative colitis, biologic therapy such as Infliximab is usually considered when moderate to severe inflammation persists despite optimal treatment with Mesalamine and Azathioprine, or when blood tests like CRP (C-reactive protein) remain elevated, and symptoms such as frequent loose stools and bleeding continue.
Since your inflammation is described as mild, but symptoms are still affecting your quality of life, your doctor may soon discuss stepping up treatment to a biologic if adjustments to your current medicines do not bring improvement. Biologics like Infliximab, Adalimumab, or Vedolizumab are very effective for inducing and maintaining remission in many patients, and they can be used safely for the long term under regular monitoring.
They are not only for severe cases but also for patients whose disease is active or unresponsive to standard therapy. Stress can indeed worsen symptoms, not by directly causing inflammation but by triggering gut sensitivity and flare-ups. Managing stress through relaxation techniques, gentle exercise, or counseling can make a noticeable difference.
As for diet, avoiding milk helps if you have lactose intolerance, and steering clear of spicy or high-fat foods can reduce irritation during active flares. The best approach is to eat a soft, balanced diet rich in easily digestible foods, stay well hydrated, and keep a food diary to identify any personal triggers.
You are doing the right thing by being proactive, and with proper adjustments and support, it is very possible to regain good control over your condition and feel much better.
I hope this helps.
Kindly follow up if you have more concerns.
Thank you.
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Answered byDr. Ashraf Ghani
Medically reviewed byiCliniq medical review team
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