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Proctitis on rectal meds, need for oral mesalamine?

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Ulcerative Colitis
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Posted 5/13/2017 8:27 PM (GMT 0)
Hi

I'm new to this forum, recently diagnosed with moderate proctitis on sigmoidoscopy in Jan. Most likely have had two previous flares over last 5 years that when scoped the symptoms had resolved and appeared normal. Started on pentasa 1 g supps at night. Had full colonoscopy in April that showed improvement but now mild inflammation in rectum. Still bowels not 100%, no blood but off.

Side note I have had on and off swollen joints for last 20 years (I'm 32 yr old male). Now this is being attributed to IBD. Should I be started on a oral 5 ASA product in addition to rectal meds??

Thanks
Posted 5/13/2017 8:50 PM (GMT 0)
You could try an oral and it might impact the rectum some but oral pills aren't consistent at reaching the rectum. Have you considered an enema ibstead like rowasa, pentasa, or salofalk enemas? They often have 4 grams or 2 grams of anti-inflammatory mesalamine. Much stronger than suppositories.
Posted 5/13/2017 8:55 PM (GMT 0)
Thanks, good idea!

I'm also concerned about progression. Any experience about oral meds preventing progression? Also thinking maybe oral 5 ASA would prevent my joints from flaring
Posted 5/13/2017 9:03 PM (GMT 0)
Progression is the bigger reason a proctitis patient might take an oral pill. Oral Sulfasalazine is both an ulcerative colitis medication and a rheumatoid arthritis medication, and therefore could help with your joints. Sulfasalazine is known to have a greater risk of other side effects like headaches though.
Posted 5/14/2017 2:09 PM (GMT 0)
One more question,

I have been taking VSL 3 for 4 months. It's expensive but I don't mind spending the money if I will get benefit from it. Any thoughts as to the benefits of probiotics?
Posted 5/14/2017 2:17 PM (GMT 0)
if you haven't noticed any change one way or the other, it seems like a good time to try something else - something less expensive maybe ?

i'm not a big fan of pill probiotics - foods seem to be a better choice -
Posted 5/14/2017 2:53 PM (GMT 0)
I believe...BELIEVE....that it is in the best interest for future possible spreading upward of the disease to use a low dosage oral 5ASA. The benefits should outweigh the justification of not until it has spread. It's not a treatment that's been proven as successful on this forum.

Regarding treatment with suppositories alone with no oral 5ASA...especially in a new patient with no experience of symptoms....enemas should be offered as full coverage into the sigmoid. Once diarrhea hits, it has spread...if it's not been a symptom in the past.

I've never used VSL....and foods that have active probiotics are in the category of mega gut discomfort, so I've depended on commercial capsule form probiotics to fulfill that requirement.

q
Posted 5/14/2017 3:14 PM (GMT 0)
Have you noticed a benefit from vsl? That's all that matters. Never buy a product and use it indefinitely based on faith or because it worked for someone else. Rather, try it, give it fair time to work for you and expect results. Try stopping vsl and see if you get worse, and if you do then it was working and you'd reintroduce. UC is so darn individual that there's nothing with universal benefit.
Posted 5/14/2017 3:17 PM (GMT 0)
As are probiotics....i would for sure consider one with reuteri in a combo of others.

q
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