Bright red blood....

Ok so hear is the deal. I have been off systemic prednisone since June of last year. Mostly, but never 100% i.e. back to the way I was pooping before I was diagnosed, in clinical remission (i.e. 1-3 BMs in the morning, mild urgency but no blood, abdominal pain, mucous, etc.). Ran a full and 1/2 marathon since then. Was on SCD, now gluten free. So some mucous returned about 4 months ago but was kept in check by nightly canasa supp.

Saw my GI 1.5 months ago who did a flex sig showing very mild rectal disease. Put me on Uceris and had me decrease Lialda to 3 tabs and cut canasa down to 2-3x per week. Ws working for a bit but the past 4 mornings I have had bright red blood on TP and in the bowl. More than I have seen in like a year. No diarrhea or increased urgency or frequency. Still able to pass flatus no problem and sleep through the night, work, etc. So overall mild but still concerning.

My concern this whole time has been if my regimen is 4 Lialda per day and nightly canasa what is my rescue regimen med if I flare through that and Uceris does not seem to work? I have come to the conclusion I may need Humira or AZA/ 6-MP.

So this morning I took two canasa and going to return to SCD. Any other thoughts would be much appreciated. Thanks!

If your symptoms got worse when decreasing Lialda and Canasa then I would go back to 4 lialda and nightly Canasa.

Generally the maximum effective dose of mesalamine is 4,800 milligrams orally (which is equal to 4 Lialda) and 4,000 milligrams of rowasa enema. Canasa is about 1,000 milligrams. So, you have that rowasa option.

Steroids are always first to threat a flare, if you can't successfully taper off then immunomodulators (Imuran, 6mp, or azathioprine) are usually added to your current medications. Immunomodulators are slow working medications, so you're usually on steroids while you wait the 6-8 weeks for the immunomodulators to work.

Some gastroenterologists are jumping straight to biologics (remicade, humira, simponi, or entyvio). Traditionally, biologics were tried after immunomodulators failed. Biologics work much faster .