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Crohn's Disease
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Posted 8/22/2009 5:46 AM (GMT 0)
I am having a colonoscopy on Monday because of my current flareup. I have been on colazal for several years, and currently am taking 40mg prednisone, which has helped with some symptoms but not all. Other than that, cipro and flagyl that we tried a couple of months ago.

I think they are going to find this is my cd flaring when they take a look. I'm wondering what I can expect them to do next. Are they likely to increase the pred? How high of a dosage will they try before giving up on it? Will they try another 5-asa type maintenance med? I'm kind of worried they will want to put me on stronger meds with more risks and side effects. I'd like to be able to be in on this decision and not just blindly accept changes that I don't understand.

I realize it could be something other than cd, but what? If I took cipro and flagyl, would that take care of any infections? My cd was originally found in the colon only, and other than having trouble with diarrhea, my symptoms haven't changed other than it just doesn't want to get under control.

Thanks for your help.
Posted 8/22/2009 1:22 PM (GMT 0)
I would think that they might suggest something like 6mp or Imuran. Many on this forum have had great success with either of these medications. Though they can take about 3 month to fully kick in. Hope that helps.
Posted 8/22/2009 4:20 PM (GMT 0)
My progression was:

Antibiotics (flagyl and cipro)
Imuran
Remicade
Hopefully I won't need another step. *Knocks on wood*
Posted 8/22/2009 5:25 PM (GMT 0)

Mine went

1. Cipro/Flagyl 2. 6MP/Asacol  3. Prednisone  4. Humira  5. Remicade  6. Imuran  7. back to 6MP

Now I'm starting a Cimzia +Methotrexate combo

Posted 8/22/2009 5:36 PM (GMT 0)
Mine was:

Pre diagnosis: Cipro and Flagyl in case I had an infection

Post-diagnosis: 1. Asacol 2. Entocort/Cipro 3. Prednisone/Imuran (tapered off pred, stayed on the Imuran, went back on pred when I came out of remission)) 4. Humira (still on Imuran, and just started vancomycin for suspected C. diff)

If the Humira doesn't kick in, my doctor wants me on methotrexate next. I did very well on the Imuran. No real side effects, and it gave me 4 good years. I wish it still worked for me.
Posted 8/22/2009 6:58 PM (GMT 0)
If you are flaring on your current meds, I highly doubt they would put you on a 5-ASA drug (or at least they wouldn't *only* put you on one), as that would not address the immediate problem. I also doubt they would increase the pred, but would instead try something new, maybe 6mp or Imuran as Nanners suggests.

During my last flare, I started off with Pentasa and prednisone, and when that didn't work to get the flare under control after a couple months, I was given the option of Remicade or a clinical trial. I did the trial, which put me in remission.
Posted 8/22/2009 8:59 PM (GMT 0)
Have they checked for C difficile? It can mimic Crohn's symptoms and is often caused by a course of antibiotics. Taking immune suppressors when you have C diff won't work and would likely make the symptoms worse.

Another poster reported that they only got a positive test for C diff after they kept their sample refrigerated prior to submitting it. Not keeping it cold resulted in negative tests.
Posted 8/22/2009 9:22 PM (GMT 0)
To echo the previous poster, my gastro told me that C. diff is endemic amongst IBD patients now (in his experience). My C. diff test came back negative, but that happens, and as I was in the hospital recently, he wanted me on antibiotics for it. I've been on vancomycin for about 2.5 days now (Flagyl is the preferred treatment, but I don't tolerate it well at all), and I am seeing a decrease in blood and mucus, as well as frequency (and last night was the first night I didn't have to get up to go to the bathroom in the middle of the night since I don't know when). So, yes, if you haven't been tested for infection, I think it would be a good idea to rule it out.
Posted 8/23/2009 12:57 AM (GMT 0)
My GE starts off with prednisone, maxing at about 40mg/day. That didn't work with my second flare, so we went to Imuran. If that doesn't work, my GE goes to biologics, Remicade being his first choice. He's never mentioned antibiotics.
Posted 8/23/2009 4:31 AM (GMT 0)
Can they tell if I have c.diff during the colonoscopy?
Posted 8/23/2009 5:03 AM (GMT 0)
C-diff does thicken the intentines or colon I think, I'm not sure if they can tell just by doing a scope, but a simple stool sample does the trick, they usually do 3 tests though, the come back false negatives a good bit of the time.

Posted 8/23/2009 8:22 AM (GMT 0)
My progression was: Asacol, CortEnemas, Prednisone, Methylprednisolone, Imuran, 6-MP/Cipro/Flagyl, Remicade, Humira, MTX, Humira/Cipro/Flagyl/CortEnemas, Methylpred/Budesonide (compounded suppositories)/Cimzia. (in the midst Prochymal)

Honestly, if symptoms are bad enough, I don't understand why docs don't just get things under control with the biologics to start with. They sound scary, but compared to years and years of steroid use... Well, I'd prefer biologics, if they work.

I 'm in a constant flare to some degree, but in April this year I took a big dive. I was "sure" i had c-diff it was so bad. Thankfully (??) it was just CD and I was put back on oral steroids. I think anything down in the large intestine will show itself when they look in the scope. Good luck... I just had one a couple weeks ago now. Hope you're feeling ok with the prep!
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