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proctitis, whats next

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Ulcerative Colitis
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Posted 8/9/2016 1:57 PM (GMT 0)
Hi everyone

I posted a while ago (can't seem to find it) for some advice as I had been flaring since april ?due to hormones (stopping breastfeeding, changing type of pill). I had 2x5 -day courses of prednisolone, my mesalazine tablets were quadrupled! (current meds should be in sig if it worked!) and I was awaiting a repeat sigmoidoscopy. I have now had this and wondered what the next steps will be:

First sigmoid (before any medication): Colitis of the rectum (severe). Musoca: extensive severe atrophy, congestion, erythema, granularity, mucopurulent exudate and multiple small ulcers.

Recent sigmoid (on meds as per sig): Inflammation up to 10cm, Mucosa: extensive mild erythema and granularity

So it looks as though my meds have definitely improved things and my flare is settling slighty, I now have no bleeding or tensmus but I still have wind, big clumps of mucus numerous times a day, urgency when needing BO. As a pre-emptive, my consultant sent me information leaflets for azathioprine. Is this really where I'm heading?

Thanks in advance
Posted 8/9/2016 2:45 PM (GMT 0)
Have you considered trying rectal enemas instead of suppositories? There are also steroid rectal enemas in foam or liquid. Either sounds like it would be worth trying. You could also try Uceris to get this controlled, but I think I'd try the enemas. Suppositories treat a very small area.
Posted 8/9/2016 2:53 PM (GMT 0)
Ditto nssg.
Id also suggest probiotics.

q
Posted 8/9/2016 2:57 PM (GMT 0)
Yes, that's an improved scope. You have extensive redness (erythema) that essentially looks like a sunburn in your rectum. The surface of the rectum is rough and grainy in appearance (granularity). Both are suggestive of mild inflammation.

You can try adding either more anti-inflammatory mesalamine in suppository (canasa or pentasa suppositories), mesalamine foam, or enema (rowasa or pentasa enema) format or a combination thereof. Generally 4 grams a day is the maximum rectal-route. I'd try more before going to the next level.

Steroid foams, suppositories, or enemas are also available and worthy of trying.

Azathioprine/Imuran might become necessary, as rectal inflammation can be very stubborn to treat. Having proctitis doesn't necessarily give you an easy pass, you still have the very hardest area of uc to treat-- the rectum.
Posted 8/9/2016 6:52 PM (GMT 0)
The corto foam helped me a lot and way easier than enemas. Hang in there!!
Posted 8/9/2016 7:56 PM (GMT 0)
Thanks for your input everyone. I'm waiting on the biopsy results from the sigmoid before my consultant will review everything, I'll have a list of points now!
Posted 9/4/2016 9:08 PM (GMT 0)
Update!

So based on the results, my consultant gave me prednisolone enemas and said to take them for two weeks. If i improve then he'll see me at my next scheduled appointment in December. If I don't improve then he wants to start azathioprine.
Well I am currently day 12, i have used the enemas every night and retained them no problem and have been keeping a symptom diary. I am still passing mucous numerous times a day, although the quantities has reduced a bit. I have urgency when needing the toilet and still get tensmus with some blood every few days.

What do you think about the two week time frame? Is it long enough for the enemas to work? Is the slight reduction in the quantity of mucous enough to persevere until December?

I'm at such a loss of what to do! In comparison to others, my symptoms really aren't that bad. But I have had them on a daily basis since April and it's getting tiring! I'm worried about going on azathioprine as I'm due to go back to work (maternity leave) next month and I'm a nurse, so I'll have no immune system just in time for winter and all the respiratory illness!

Opinions would be very much appreciated!
Posted 9/5/2016 12:35 AM (GMT 0)
I hope the pred. enemas help you, some people report that they do and some that they don't. After that 2 weeks keep asking for mesalamine enemas, they are very different than pred. enemas and can be used long term. I personally would use them for a month before going to a higher level of oral meds because enemas are medically effective for proctitis whereas oral meds may not reach that low an area.

You can do some online research for medical papers on proctitis and mesalamine enemas if you want to prove this to your GI. It shouldn't be necessary but maybe you really need to prove it to the consultant (is that a nurse?)
Posted 9/5/2016 3:33 AM (GMT 0)
I personally think it's very important to "get in front" of the disease. I was never able to get to full remission but felt I was always good enough. My dr really wanted me to add aza to boost my healing but I was afraid of it. Things went downhill for me fast. Thankfully I was able to control things and now with aza and remicade I feel really good. I work with kids every day and I haven't been sick more than usual at all. I even stayed healthy as strept throat made its way around my house. Twice. It's a hard decision but I'm glad I made it. Good luck.
Posted 9/5/2016 12:43 PM (GMT 0)
Azathioprine shouldn't make you a whole lot sicker than normal. I wasn't. You should be vigilant on hand washing, as many colds and flus are transferred from handshakes, doorknobs, and other shared objects. We've got posters who work in medical offices, are teachers and on these medications. It's manageable.
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