What would you do?

Have you not tried an immunomodulator (imuran or 6mp)? Alternatively you could up the dose of remicade. Id also recommend adding in some non-medicinal therapies like resistant starches, curcumin, etc

I avoid at all costs. I've always ended up in a severe, severe flare after. A stool test for CRP can tell you the level of inflammation.

You can try increasing VSL or adding another probiotic.

First of all two months is nothing. You need to be patient. Unfortunately your remission has ended.

Why did you only start Prednisone at 20mg? I believe 40mg is the optimal starting point. You say you've tried a whole bunch of stuff, but only in two months? My apologies if I am misunderstanding you but how do you know whether anything was working or not working when you barely gave it a chance?

Also, if I were you I would not get the scope. But I would stop panicking and accept that you might not be able to fix this without some trial and error over a longer period.

There's absolutely no point in upping your dose of pred. Even if it works wonders at 40mg, what goes up, must come down - that's doubly true for pred. If you up your dose all you will do is incur a larger risk of side-effects, plus face exactly the same sh!t you're facing now in a month's time.

In fact I'm wondering if you're already pred dependent, considering you can't seem to get off it. I don't mean to be depressing, but I would consider the possibility that Remicade is not working and it is pred rather than Remicade which is controlling your symptoms. I might be wrong, but I would at least run it by your GI.

And yeah, I'd probably have a colonoscopy if I thought I had inflammation higher up.

If you are correct that anti-b's started your trouble then that's what I'd up/change. You take VSL#3 so maybe take more and add some other probiotics such as reuterii or plantari. Some people have tried using VSL#3 as an enema which is not that far fetched but I've never done it.

95%Curcumin/Turmeric supplement is an anti-inflammatory and possibly anti-biotic. Not sure if it can settle your gut bacteria but I've been taking it for many months with no side effects and beneficial results.

These are the things I go to when my gut gets out of whack: clay water (anti-bacterial), wormwood (couple drops in water once a day for 2-4 days) and daily 95%Curcumin capsules, start slow with 500 mg. and then increase up to 4-5 g. And when all else fails I take an oil of oregano capsule which kills bacteria (WOO never hurt my gut but did cause IBS).

Clay should not be taken at the same time as RX because it will dilute the RX effect.
If you try these do not add everything at once. I'd start with clay water as it is fairly easy on the gut, quiets mine right down. 95% Curcumin is daily for me but not the kind with pepper added. "They say" pepper enhances the curcumin but my gut dislikes piperine/pepper.

Good luck.

I also think you should have started at 40 mgs of pred. None of the meds technically heal. Pred is good at stopping the immune attack and it is also an anti-inflammatory. Of course you can't take it long term but since your mtnc meds seemed to have been good enough to keep you in remission before a short term course of pred at the correct dose may have been enough to help your body heal itself to the point where when you tapered back the same mtnc meds you were taking before might have worked again, they just couldn't do it all by themselves without help from the pred. That's why your doctor put you on pred to begin with but you didn't take it at a high enough dose to actually do the trick. I would have also upped the VSL dosage if you didn't do that.