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Posted 1/19/2017 7:22 PM (GMT 0)
Hi guys. I registered years ago and have been inactive as I was in remission, but as they say, all good things come to an end and I've been in a flare for the past 2-3 months. Here's where I'm at...


  • DX'd with left sided UC several years ago, prescribed 5-ASA oral (maximum dose daily)
  • Remission for 1 year, then flare, brought under control with 5-ASA enema
  • Another remission lasting 3 years
  • Got careless with my oral meds, was under constant stress for nearly a year, and then flared up again
  • Resumed oral meds regularly, resumed 5-ASA enemas, almost had things under control but I stopped enemas too soon (after 3 weeks), so symptoms came back
  • Been on 5-ASA enemas and max oral 5-ASA dose for the past 6 weeks, BMs twice a day, little blood in the morning but slightly more blood in the night
  • Had a colonoscopy recently, doctor says that my UC is still left sided (i.e. has not spread) but is still active, especially at the splenic flexture


After the colonoscopy, my doctor said that the 5-ASA enemas and 5-ASA oral meds should have brought the flare under control within the 6 weeks that I've been on the meds. I didn't ask why the 5-ASA seems to have lost its efficacy. Now he's given me something called "cortiment", which is basically a steroid like prednisone with a coating that's supposed to limit absorption to the gut. He says that I'm supposed to take it for another 6 weeks, and if my symptoms resume, I'll be taken off the 5-ASA and onto the Imuran for the long term.

Here's what I'm so confused about... if my UC hasn't spread, why has it suddenly stopped responding to 5-ASA? Shouldn't it have settled down after staying on the max oral dose + enemas for this long?

Secondly, I don't want to go down the steroid path. Has anyone here used cortiment before? Is it as bad as prednisone?

(I added a subject)

Post Edited By Moderator (iPoop) : 1/19/2017 12:56:48 PM (GMT-7)

Posted 1/19/2017 8:06 PM (GMT 0)
Sorry to hear you are flaring.

"Here's what I'm so confused about... if my UC hasn't spread, why has it suddenly stopped responding to 5-ASA? Shouldn't it have settled down after staying on the max oral dose + enemas for this long?"" Ulcerative Colitis has a tendency to get more severe over time, it doesn't necessarily have to spread. Each medication has a maximum effectiveness, and it's likely that your ulcerative colitis is now more severe than the 5-ASA alone can handle. You can try Cortiment and see if that's enough to tame it. I'd bet that Imuran is likely within your future.

""Secondly, I don't want to go down the steroid path. Has anyone here used cortiment before? Is it as bad as prednisone?"" Names are different country-to-country, but from what I can tell Cortiment is the same thing as Uceris is here, and another name I know for it is Clipper. All of those are delayed-release medications that use your body's PH to determine when to release the steroids (specifically a Budesonide steroid), that release once they reach the large intestine. The advantage of this approach is that the steroid is 90 percent topical and only 10 percent systematic. Where as prednisone is 100 percent systematic. And it's that systematic element that gives us the dreaded side effects. So, I can't say Cortiment won't have side effects, but what it does give you would be are very, very mild compared to prednisone (I'd say Cortiment is the equivalent of being on 7-12mgs of prednisone as far as side effects go).
Posted 1/20/2017 12:42 PM (GMT 0)
Thanks for the response.

I got the report from the doctor today, and it says the rectum and sigmoid are fine, most likely due to the 5-ASA enemas. It's the splenic flexture that's inflamed. I was told that the 5-ASA loses most of its potency by the time it gets there, and the enemas don't reach that far up.

I guess what changed is that I've never had this much inflammation that far up. Does this still warrant switching to Imuran? I mean, the rest of my colon still seems to respond to the 5-ASA.
Posted 1/20/2017 1:30 PM (GMT 0)
Give the cortiment a try. I was on uceris and it worked really well with virtually no side effects as ipoop explained above.

If that doesn't work consider the imuran. You have to treat the affected area and concentrate on what will heal that not the healthy area. I have an area further up 3/4 of the way which heals last each time and it causes me the most symptoms.

It's not uncommon for meds to unexplainable working for us. Apriso put me in remission for a year than suddenly stopped working others have had similar experiences with biologics. I don't think we know why.

Good luck!
Posted 1/20/2017 1:55 PM (GMT 0)
So if Uceris/Clipper gets rid of the inflammation, I can continue the 5-ASA?
Posted 1/20/2017 2:39 PM (GMT 0)
Nobody can say for sure whether 5ASA alone is enough for your maintenance from this point forward. Generally two schools of thought and either can be right, only time will tell which is right for you.

First it takes more meds to beat a flare and achieve remission than maintain it (meaning cortiment might be enough and later return to just 5ASA).

Second, your UC flared because your maintenance medications weren't strong enough, and once you discontinue cortiment then you'll just flare again unless you add Imuran. I'm a bit pessimistic as often it's a progression up the med ladder for most in that situation. If it were me then I'd just start the Imuran with the cortiment/uceris/clipper stuff (especially considering the fact Imuran takes a minimum of 6-8 weeks to work).

However, I understand if you want to first try without immunomodulators. There's no other way to know if Imuran is truly necessary.
Posted 1/20/2017 3:08 PM (GMT 0)
many folks on this forum find non-med relief of symptoms - diet mods, LDN, supplements, etc. - have you tried anything like that ?
Posted 1/20/2017 3:28 PM (GMT 0)

soynomore said...
many folks on this forum find non-med relief of symptoms - diet mods, LDN, supplements, etc. - have you tried anything like that ?

Yes, Metamucil worked wonders for me when this flare first began. No blood, mucus, or loose BMs. However I stopped taking it right after I felt relief and continued eating spicy foods, which then brought the symptoms back. Metamucil still helps, but not nearly as much as it did the first time.

iPoop said...
Nobody can say for sure whether 5ASA alone is enough for your maintenance from this point forward. Generally two schools of thought and either can be right, only time will tell which is right for you.

First it takes more meds to beat a flare and achieve remission than maintain it (meaning cortiment might be enough and later return to just 5ASA).

Second, your UC flared because your maintenance medications weren't strong enough, and once you discontinue cortiment then you'll just flare again unless you add Imuran. I'm a bit pessimistic as often it's a progression up the med ladder for most in that situation. If it were me then I'd just start the Imuran with the cortiment/uceris/clipper stuff (especially considering the fact Imuran takes a minimum of 6-8 weeks to work).

However, I understand if you want to first try without immunomodulators. There's no other way to know if Imuran is truly necessary.

Yeah, it's just the risk of cancer that scares me the most. I'm newly married and the thought of having yet another ticking timebomb inside of me is just a depressing thought.

The one thing that gives me hope is that according to the report, the 5-ASA enemas still seem to be effective on the parts of my colon they can reach. My GI says that enemas can't go as far as the splenic flexture, which is where my inflammation is.

What's it like being on Imuran? Will there be weight gain, hair loss, mood swings, etc along with the cancer risk?

Post Edited (Max89) : 1/20/2017 8:35:20 AM (GMT-7)

Posted 1/20/2017 4:00 PM (GMT 0)
I've been on 6MP for over 3 years now and I've yet to experience a side effect from it. about 20 percent in initially get nausea when starting it (take med before bed with a snack to decrease odds) but that goes away in a few weeks for those who experience it. Beyond that side effects are quite rare (this is no prednisone).

Well the idea of increased cancer risk is what scares people spitless. If you look at the actual risks versus benefits then it's not so scary after all. 70 percent odds that Imuran will improve your ulcerative colitis symptoms. The lymphoma risk is 4 out of 10,000 (or 0.04 percent) compared to the general population's risk of 2 in 10,000 (or 0.02 percent). Of those who get it, 66 percent are able to put it into remission. So we're talking really long odds.

In my mind, having untreated UC inflammation is muchn much more likely to cause a cancer than Imuran is. As our colorectal cancer odds are increased when untreated inflammation persists for prolonged, longterm scenarios.

If you want to take a deep dive into risks versus benefits then give this a read from the Crohn's and Colitis Foundation of America. It helped me greatly in my decision.
Webcast: programs.rmei.com/CCFA139VL/presentation/player.html
Transcript: http://www.ccfa.org/assets/pdfs/risk-and-benefits-transcript.pdf
Posted 1/20/2017 4:24 PM (GMT 0)
Thanks, I'll give that a read.

Is it possible for us to build up resistance to 6MP as well? I noticed quite a few people on here who are taking 6MP but have also had to use Prednisone.

Lastly, does 6MP generally cost more than 5-ASA?
Posted 1/20/2017 4:43 PM (GMT 0)
6MP is a generic, so pretty inexpensive in UC doses. Imuran/azathioprine is also available in generic.

The prognosis (course) of UC can be a bit unpredictable. So none of us know the exact course that our UC will take or what treatments we will ultimately need. It's a roll of the dice. Some of us have a very mild mannered case of UC and have been only on 5ASA for decades, with the occasional flare that's easily treated. Some of us have more aggressive cases of UC and ultimately need immunomodulators or biologics to treat us. For 25% surgery quickly finds them. Unknown if you'll eventually need stronger treatments. Usually UC is the most aggressive within the first 5 years of diagnosis and will likely need stronger treatments within that time frame, if it's going to happen.

Everyone flares eventually, but with a good maintenance treatment one should get 2 years, 5 years or more between flares. Flares tend to be milder and shorter when you have a good maintenance treatment.
Posted 3/6/2017 5:10 PM (GMT 0)
Quick update.

After 8 weeks of Cortiment 9mg (Uceris), my bleeding and loose stools have fully resolved and everything is back to normal. I hope it stays like this. I don't want this to be a temporary remission...
Posted 3/6/2017 5:19 PM (GMT 0)
I am also taking 6MP for a couple of years now. No side effects. I also took Uceris at one point. I have been in remission for a couple of years now.
Posted 3/6/2017 7:12 PM (GMT 0)

iPoop said...
6MP is a generic, so pretty inexpensive in UC doses. Imuran/azathioprine is also available in generic.

The prognosis (course) of UC can be a bit unpredictable. So none of us know the exact course that our UC will take or what treatments we will ultimately need. It's a roll of the dice. Some of us have a very mild mannered case of UC and have been only on 5ASA for decades, with the occasional flare that's easily treated. Some of us have more aggressive cases of UC and ultimately need immunomodulators or biologics to treat us. For 25% surgery quickly finds them. Unknown if you'll eventually need stronger treatments. Usually UC is the most aggressive within the first 5 years of diagnosis and will likely need stronger treatments within that time frame, if it's going to happen.

Everyone flares eventually, but with a good maintenance treatment one should get 2 years, 5 years or more between flares. Flares tend to be milder and shorter when you have a good maintenance treatment.

fantastic comment, friend. I feel this hit the statistics fairly well and is more realistic. I have come here as a mild mannered UC'er looking for some other opinions of people like me. I think it is a blessing though to have this condition and be able to go years in between flares using just the 5ASA.
Posted 3/6/2017 7:14 PM (GMT 0)

Max89 said...
Quick update.

After 8 weeks of Cortiment 9mg (Uceris), my bleeding and loose stools have fully resolved and everything is back to normal. I hope it stays like this. I don't want this to be a temporary remission...

Thanks for the update! Glad to hear its working for you for now
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