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Posted 3/15/2011 11:19 PM (GMT 0)

I've just spent some time reading the2010  UC treatment guidelines published by the American College of Gastroenterology. They are well worth a read and really reinforce the idea of "treating from both ends" that many here have supported. For example, it states:

Some patients may achieve maximum benefi t from combination

of oral and topical therapy; a combination of oral mesalamine 2.4

and 4 g per day mesalamine enema was more eff ective in achieving

clinical improvement, as well as an earlier response, than either

agent alone

The document is available at http://gastroindia.net/wp-content/themes/gastro/images/practice_guidelines_pdf/UlcerativeColitis.pdf

Posted 3/15/2011 11:25 PM (GMT 0)
It seems that idea which was presented to me 22 years ago is still nixed by many GIs....

Maybe it's not dramatic enough...but it is expensive.
q
Posted 3/15/2011 11:31 PM (GMT 0)
That is unfortunate as they are ignoring their own published guidelines based on the latest evidence. I wonder if they assume their patients won't tolerate or be compliant with the topical rectal meds. If so, that is condescending in my opinion.

In my work, I have to evaluate the scientific evidence. I hope my physicians are doing the same, but I am an information hound and always try to learn as much as I can on my own. When I first flared up, I didn't have it in me to read anything too technical which is why I am so grateful to this form, and to folks like you, Heather. But now that I am feeling better, I am putting my mind back to work and thinking critically. I am glad to read that the general approach my doctors have taken is appropriate. The guidelines also document the benefits of the suppositories vs. enemas. My disease as of last year was only 6 cm so the suppositories should have been sufficient but I am guessing this flare has extended the disease so that the enemas are more effective in getting farther up the colon.

The guidelines also discuss  maintenence of remission which will be helpful as well. 

Posted 3/16/2011 12:04 AM (GMT 0)
I think doctors get feedback from patients that they don't "like" enemas and end up not recommending them.
People want to take a pill and make everything OK. Enemas aren't sexy, they're messy and embarrassing.
It takes a strong doctor to speak strongly to a patient "You need to use these enemas. They work."

When you think about it we are really customers and whether they consciously do it or not doctors want to please us. Yes they want to heal us but also not lose us as customers.
Posted 3/16/2011 2:16 AM (GMT 0)
I keep telling my doctor how many patients have to actually BEG for rectal meds. He's surprised.

He says...I wish more patients would use them...most if not all, should be.

I don't think most docs follow a general approach...initially, most use prednisone....that has lessened somewhat, or it's oral 5ASA with pred...

I guess the basics are maybe too commital, too expensive, too many refills, takes too long...etc.
 It's not for everyone...

I also suspect that docs who have their patients on pred initially can set them up for other med failure...especially for 5ASA meds.


REgarding supps compared to the enemas...the enemas would reach into the sigmoid..but a nicely inflamed butt would benefit over supps regardless of how low...but the supps can be used to supplement or for tapering.

Happy research! looking forward to the sharing..

q

Posted 3/16/2011 12:54 PM (GMT 0)

quincy said...


I guess the basics are maybe too commital, too expensive, too many refills, takes too long...etc.
It's not for everyone...

I picked up my first prescription for Canasa, the co-pay was $25, but the actual cost was $1016!!!
Posted 3/16/2011 8:15 PM (GMT 0)
as in one thousand, sixteen??

how many canasa??

q
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