Asacol/Lialda users: Has pred been necessary to stop your flares, or just more mesalamine?

I have read a number of posts recently where folks say they can head off a flare early on by adding in mesalamine enemas. This made me curious: how many of you who normally take Asacol or Lialda (not Remicade or 6mp) typically stop a flare by upping the dose of mesalamine (either through enemas/suppositories or taking more orally), and how many typically need to do a course of prednisone?

My first time, it was mild UC, only left side. And Colazal (the same group as Lialda) and enemas worked, they put me in remission for years (I very seldom used Canasa suppositories). My big-time flare up, mid-April 2011 and my GI put me on Predn and Lialda the same time, so I have no idea what would've happen without steroid. I'm still tapering, hoping I can do it without ANY problems from my guts

Different forms and doses of mesalamine and sulfasalazine have never seemed to make a difference for me. Once I start having problems, it continues to go downhill until I take prednisone for a couple weeks. I've had long remissions (longest was four years) with just azathioprine, fish oil, and probiotics.

I have not achieved remission in the 18 months since diagnosis. So I am unsure how to use the word "flare" because what I have is upticks with a lot of D, increased bleeding, and problematic urgency, in an otherwise base level of consistent mild D, some bleeding, and mostly controlled/non-problematic urgency.

My GI wanted to give oral 5-ASA (Lialda) lots of time to work, so was hesitant to prescribe the enemas. On 3 occasions I did a Pred taper beginning with a modest 30mg dose. This helped get me back to a more baseline level of colitis. We added 6mp, but I am not seeing therapeutic benefit yet. After last time, I was told to stay on Pred at 15mg until the 6mp kicked in.

The last colonoscopy showed right and transverse colon had responded pretty good to 5-ASA, but the left and sigmoid colon were still angry and bloody. Based on this, I am starting 5-ASA enemas. Did the 1st one last night. Managed 4 hours of retention, but think I can get to 8. I am hoping that since oral 5-ASA worked in half of my colon, that the rectal 5-ASA will work as well in the other half. Or, that the 6mp will kick in. We just upped the daily dose by 25mg, to 125mg. I also wonder if I can vary the acidity of my diet, and perhaps control stomach acid, and manipulate how far Lialda get in my colon.

I would like to taper off the Pred even thought 15mg is not a large dose. I am concerned about being on it indefinitely.

If I was traveling, or had a sudden uptick, I would not hesitate to contact my GI and begin a bump in Pred medications. I do not have an more sick leave, and am running out of vacation, and have done not much of anything professionally or personally for the past 18 months, so I will choose the side effects of Pred over losing any more of my life to this disease.

The 3 morning pills are taken with coffee and a glucernia shake. The 4th pill is taken after whatever I eat for lunch.

I was using an OTC probiotic and Citricell fiber, but in my most recent uptick, I suspended all but prescribed medications in a bit of a panic. I stopped 4000 units of vit-D because of the oil. I stopped multivitamin, I stopped the daily iron because of digestive upset, I stopped the probiotic because I wondered if somehow it was activating my immune system, and I stopped the Citricell because, despite its low-gas marketing, I wondered if it was giving me gas. It was also pretty hard to take all these pills in the morning, and they did sit heavy on my stomach.

I just restarted the vit-D and wil restart another supplement every two weeks. While it may have been coincidence, I had symptoms noticeably subside after I dropped all the OTC pills and began the ginger & turmeric teas.

I am now trying to investigate if this was coincidental or if one of these (like maybe the citricell) was irritating me. Other fiber pills have given me lots of gas.

Just as an aside...do you eat any regular actual food? Are you diabetic as to need the glucerna shake?

What vitamin D are you taking that's in oil form?

I'd consider another probiotic.

I'd suggest you take the Apriso 2 during the morning and 2 at night.

It sounds as though you can try some tweaking with diet, probiotics and fibre. Split the supplements morning and night, etc.

q