Colonoscopy Results on Remicade w/Many Choices!!!

A couple of suggestions for best care in this kind of situation:
1) blood work to test for ATI's (Antibodies To Infliximab)
2) blood work to measure trough levels (blood levels of infliximab right before you're due for next infusion, so levels would be at their lowest).

Based on those two things, you'll have a better idea how to proceed.

If you have ATI's: it might make sense to switch to Humira AND to add Imuran (adding imuran has been shown to decrease antibody formation to the accompanying biologic).

Simply monitoring the disease wouldn't be an option I'd suggest, because if you have 'marked inflammation' even with Remicade, chances are high that with no meds it could progress quickly to a stricture and/or fistula.

As for questran, it is useful in reducing the diarrhea that comes from when you have inflammation in the TI, leading to poor re-absorption of bile salts (bile salts are secreted into the upper small bowel, help with digestion, then get re-absorbed at the end of the small bowel. If they aren't re-absorbed, they go into the colon, irritate it and cause d). So questran can help with that symptom if you have it, but it doesn't reduce crohn's inflammation.

If you don't have ATI's:
1) If your trough levels are low, you should continue with Remicade but increase dose and/or frequency, and also consider adding Imuran (combo works best and also would help prevent antibody formation).
2) If your trough levels are good, that means you're just not responding to Remicade as well, and it might be a good idea to switch to Humira.

Thanks Beave, my blood test did not reveal antibodies, and the most recent test for the blood level of Infliximab was very low, at the lower dosage and 12 week frequency. Based on the fight to get insurance to cover the test, I don't believe my Doc will order the test again since the last dose increase (not sure how much he increased it, perhaps from 3kg to 5kg, and also 12 weeks to 8 weeks).

I have had 2 infusions at the slightly higher dose and frequency with no change in my symptoms. My bloodwork is all good otherwise. So it sounds like you agree with the Doc's recommendation to increase the dose/frequency of Remi first. If that does not work, add Imuran as opposed to just switching to Humira.

For the diarrhea, it is pretty mild compared to some others on this forum, I go perhaps 3-4 times a day but feel exhausted after for much of the day. If I don't go that often, my energy level is good. I believe the Doc wanted me to increase the Imodium first to see if that helps. If it doesn't, I will def. consider the Questran. Thank you.

My husband had a flare up of crohns when he was at 5mgs/kg very 8 weeks dose. The doc treated his flare up with some pred, but also increased his dose of remicade to 10mgs/kg every 8 weeks (so, essentially double dose). This was back in 2011. Since then, no flare ups, knock on wood.

The doc said since remicade works so well for my hubby, before taking him off it, he'd try every 6 weeks, and even every 4 weeks on the 10mg dose before switching him over to a different drug.