UC Relapse - GI suggests to go back to a short predisone taper

2400mg isn't really a high dose. Many of the users here take the max dose which is 4800 mg and use rectal medications. Have you spoken to your GI about increasing your Asacol dose or about adding rectals? It may just be that Asacol is not for you. There are other similar medications that may work better. You could try Colazal or Pentasa or Sulfasalazine. There are some options but sometimes when one is not effective, none are. The next step a traditional doctor would recommend if you couldn't stay stable with mesalamine medications like Asacol would be 6mp or Imuran. I hope you feel better soon!

Hi -

Well.... good question. The way I experience it all is that the Asacol sometimes isn't strong enough on its own to squelch a flare. And, for that matter, it doesn't keep me from having flares even though I've been on it a long time - but I do believe my flares are less frequent and less severe than they would be without the Asacol.

Many people, when they taper off Prednisone, have a rebound of their symptoms. A slower taper will sometimes help avoid that.... perhaps your taper was a little fast?
(The gut takes an incredibly long time to really heal, in my experience, so a few days without blood doesn't mean the tissue is really healed and strong.)

Yes, going back up to 10 and then down might help...... or, if I were in your shoes, I would ask to try the rectal meds - either steroid enemas, since you've been on the steroids with good repsonse, or the Rowasa, related to Asacol - very safe, (some of us continue them twice a week or so in remission in hopes of prolonging the remission....).

I, too, have pancolitis, and even though the rectal meds don't reach all the way up, they have gotten me out of many a flare without having to resort to oral pred.

Sorry, I got interrupted while writing.... but I hope this helps some.

are there any stories out there with permanent remission or 20 flare-free years? 

i was in remission for 10 years, and have been flaring on and off the past 5 straight years....such a weird disease

My GI said the same thing when I had a relapse. She wanted me to taper off on Pred starting at 30mg for 10 days then 25mg for 10 and so forth. She also wanted me to take Imuran with it. I refused to take the Imuran because she hasn't tried me on any ASAs so far. But my GI seems to have the same logic. When I flare she puts me back on Pred because according to her the 5ASAs are not designed to stop a flare, they're designed to maintain remission. Pred is what fixes the flare. So perhaps your flare was never in control and you need more Prednisone. I was on 40mg of Pred and once I stopped using it my symptoms also returned (bleeding, tons of BMS ect.) which suggests that my UC was still not in control. It could be that you stopped seeing blood in your BMs but inflammation was still occurring. Regardless, I think starting you up on Prednisone again is pretty standard but this time around make sure the 5ASA you use is effective. Perhaps ask your GI to up the dosage or try you on a different one. Unfortunately a lot of these medications are trial and error because we all react differently to different medications.

Loves-Pearls, that's a long time on 40 mg. Since April? Hope you get off soon.

My doc pronounced me in remission after I got off pred and told me to drop from 12 Asacol to 6 a day. I flared seriously within a month and had to go back on prednisone and it took me another four months to taper off even though the flare improved in a l couple of weeks and just remained limited to the rectum. For pancolitis people, Asacol doesn't reach the rectum so enemas, enemas, enemas. Very important.

Hi all,

Since this thread got bumped to the top recently, just thought I'd update.

After posting I followed the forums advice and began by asking my doctor for rectals. He was already thinking about 6mp, but gave in after realizing my cscope had shown very little inflamation beyond the sigmoid colon.

As soon as I added the rectals (while still on 15mg of prednisone) the bleeding and mucus went away completely.

Then as a I slowly tapered 15mg -> 10mg -> 7.5 -> 5mg -> 3.75mg -> 2.5mg -> 1.25mg, I began seeing a little pink mucus at 1.25mg. I decided to finish tapering off the prednisone and saw my doctor a week after I was completely off.

I asked him to up my Asacol dose, which he agreed to instantly after realizing I was only at half of the max possible. After increasing my AsacolHD dose from 2400mg to 3200mg (just 1 pill a day extra) I am feeling quite well. Still some blips now and then, but no urgency and 1-2 BM's per day.

Moral of the story: Information on this forum is golden and doctors in this profession are increasingly playing a game of monkey see monkey do...so I guess it is up to us sufferers to make best guess decisions for ourselves.

Thanks to all again!