Methotrexate is given weekly as an intramuscular injection of 15 to 25 mg. Side effects are rare and include leukopenia and hypersensitivity interstitial pneumonitis. Hepatic fibrosis is the most severe potential sequela of long-term therapy. Patients with concomitant alcohol abuse and/or morbid obesity are more likely to develop hepatic fibrosis and therefore should not be treated with methotrexate. It is prudent to obtain a baseline chest radiograph and to monitor complete blood count, liver function and renal function every two weeks until the patient is receiving oral therapy, and every one to three months thereafter. Before methotrexate therapy is initiated, the risks of treatment and the possible need for a liver biopsy should be discussed with the patient.
Stress appears to play a role in the exacerbation of Crohn's disease. 32 While no adequate studies demonstrate the benefit of relaxation techniques for Crohn's disease, studies have been done assessing psychotherapy as treatment. One study 33 showed improvement in patients' coping ability and psychologic well-being. Low-impact exercise programs also have been shown to improve patients' quality of life and bone density, an important consideration with chronic steroid use. 34 , 35 Generally, patient education, relaxation techniques, simple exercise programs, and involvement in support groups may help improve quality of life for patients with Crohn's disease.
Skipping meals is not advisable. Ensure that you eat regular meals, even small meals, as hunger and increased gastric acidity can cause belching. The pain under your left breast may be indicative of a number of conditions but I would suggest you consider a hiatal hernia or hyperacidity as a possible diagnosis. A hiatal hernia may explain a number of the symptoms that you are experiencing but your doctor will undertake the necessary investigations to confirm or exclude these conditions. Several foods and lifestyle factors can aggravate the symptoms associated with a hiatal hernia beyond just stimulants like caffeine, nicotine or alcohol. Spicy foods and other irritants (possibly coffee creamer although it is not common) could be aggravating your condition.