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mesalamine foam and enema

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Ulcerative Colitis
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Posted 5/25/2018 2:41 AM (GMT 0)
Hi All

I have been flaring since last 6 months. Despite being on nightly enemas i'm seeing on and off bleeding. Recently I've added hydrocortisone foam to my regimen but that didn't help and infact it made the symptoms worse. I know that the last resort is to go for oral steroids if the bleeding is not coming down completely. Before that i want to know if any body tried mesalamine foam in morning and enema in evening and if it helped? I'm currently on suppositories in morning and enema in evening and is not helping to stop bleeding completely and i'm thinking foam can cover much greater area compared to suppositories and that can make a difference? Want your ideas pls...
Posted 5/25/2018 4:45 AM (GMT 0)
What are your bms like....bleeding how?

q
Posted 5/25/2018 8:43 AM (GMT 0)

quincy said...
What are your bms like....bleeding how?

q

Hi Quincy. I have formed stools going around 2-3 times a day but still see occasional bleeding but not much. I see some tiny amount of blood and mucus once in 3-4 days. I see there was no blood at all for a week or so and i was thinking like i'm on the way to remission but bleeding comes back after that. This is happening since last 2-3 months and not heading towards complete remission. I'm on nightly enemas since last 3-4 months and is not helping towards complete remission. So i am thinking it is time for me to go for some stronger medicines like steroids.
Posted 5/25/2018 12:58 PM (GMT 0)
I've had luck with twice daily 4.0 gram/60ml mesalamine, retention enemas. It really makes no difference if you take them both before retiring for bed, or take them at different times of the day. I'd administer one, immediately administer the second, and then retire for the night. My gasteroenteroligist suggested trying this for mild inflammation, similar to what you are experiencing. I did the 2x daily enemas for 2-months, then returned to the normal once daily dosage. It cleared up the symptoms within a few weeks. Continued longer to make sure the inflammation was gone, and I was fully-healed.

I'd give it a try before resorting to prednisone. Treating mild inflammation with mild medications first, is always worth a shot, rather than get out the nuclear-option of prednisone. Trying to avoid the pred is always worth trying when it's mild.
Posted 5/25/2018 5:10 PM (GMT 0)
Hi....what oral mesalamine exactly? And are the mesalamine enemas 4g?

What is the location extent of your UC?

What were your worst symptoms before meds?

What probiotic?

q
Posted 5/26/2018 5:34 AM (GMT 0)
Hi Quincy, I'm currently on 3.6 gms of oral mesalamine and enema every night and 1 gm suppositories in morning. Still i see some mucus and blood occasionally. I'm on this regimen since last 4 months but still not able to acheive full remission. So, advice is needed whether I can hang on for this few more months or I should go and seek for oral steroids?
Posted 5/26/2018 12:31 PM (GMT 0)
"Some blood or mucus occassion... should I ask for prednisone? " No! Prednisone is for when you're absolutely miserable and flaring badly. Instead, consider higher doses of oral mesalamine and adding rowasa enemas.
Posted 5/26/2018 1:32 PM (GMT 0)
4g enema?
Stick with the regimen.

What probiotic?

q
Posted 5/27/2018 6:12 AM (GMT 0)

quincy said...
4g enema?
Stick with the regimen.

What probiotic?

q


Yes Quincy. It is 4gm enema i'm using. Probiotic which i'm using says on the pack that it has 2 billion stains of bacteria. Does it make any difference if i take probiotic which has more stains? My doctor says probiotic does not make any difference unless colitis caused by infection.
Posted 6/4/2018 4:54 PM (GMT 0)
Hi folks,

Here is an update on my progress. I've added mesalamine foam to my regimen recently and i've seen great improvement. Now i've completely replaced the enema with foam and i'm seeing great results and i've not seen blood since last one week. Here is my question how come i was bleeding on enema for months and blood ceased within one week of using foam? Has anybody experienced this?
Posted 6/6/2018 12:15 AM (GMT 0)
That is great news! I am so jealous as we can't get the mesalamine foam in the USA and I would love to try it. I bet it is easier, less messy and no laying down for 30 minutes (ahh, the freedom of that). So glad that it worked for you.
B
Posted 6/6/2018 5:51 AM (GMT 0)
Hi...is the foam 1g dosage?

Great to hear you have improvement....reason for difference might be different preservative.

Regarding the probiotics question...I take a total of 100 billion at bedtime, and my opinion are they are important to take.

q
Posted 6/6/2018 6:08 AM (GMT 0)

hateuc said...
That is great news! I am so jealous as we can't get the mesalamine foam in the USA and I would love to try it. I bet it is easier, less messy and no laying down for 30 minutes (ahh, the freedom of that). So glad that it worked for you.
B

My doctor thinks that the enemas are bypassing the rectum as the liquid drip down the colon quicky where as foam will not drip down quickly and it will stick to mucosa very well and that could be the reason for me to improve with foam.

Quincy, I will add probiotic with more CFUs as suggested.
Posted 6/6/2018 5:54 PM (GMT 0)
It doesn't bypass the rectum since the nozzle isnt the length of the rectum, thankfully).
Is the foam asacol? And is it 1g?

q
Posted 6/6/2018 9:25 PM (GMT 0)
I actually keep squeezing as I withdraw the enema to cover the very bottom, but yet still the bottom acts up. I need to use Anucort supps about 2-3/week to keep it under control. I would still love to try that foam. I wonder when the US will get with the times--I guess it will depend when pharma will allow it. I believe it has been at least a decade already. (roll eyes)
B
Posted 6/7/2018 2:08 AM (GMT 0)

quincy said...
It doesn't bypass the rectum since the nozzle isnt the length of the rectum, thankfully).
Is the foam asacol? And is it 1g?

q



I think we need proper technique while squeezing the liquid out of the bottle to cover very end of rectum.

I am from India and the foam is made by the company called Cipla. Yes it is 1gm mesalamine for each actuation containing 14 actuations in total.
Posted 6/7/2018 4:13 AM (GMT 0)
How hateuc explains it is how Ive done it for a very long time. So, technnique is helpful.

Keep us updated how you do on the foam enemas.

q
Posted 7/30/2018 10:37 AM (GMT 0)
Hi All,

Here is an update on my progress. I have finally had my scope done today after one year of agony with unresolved symptoms. They found some extension of the desease to transverse colon which i never had. They have found superficial ulcerations in transverse and descending colon while sigmoid and rectum looks normal. When i've asked my GI why isn't the ulcerations in desending colon not resolving and why the desease extended to the transverse colon he is putting the blame on me by saying that I've given up liquid enemas and started on foam enemas which will not reach that part. When i ask the question that why orals aren't working he had no answer. Has anybody experienced that orals are not doing any thing but only rectals are working. Please suggest the better oral medication for left sided colitis.
Posted 7/30/2018 12:20 PM (GMT 0)
Curious on why your daily mesalamine is so low? What kind are you taking? For most, 4.8 grams per day is the maximum oral (there are some exceptions like apriso). A daily 4.0 gram mesalamine enema would help as well.

I'd wonder if you should be on immunomodulators like azathioprine/imuran/6MP...
Posted 7/30/2018 1:43 PM (GMT 0)
Doesn't sound like a healing pattern of UC, but hopefully, the doc will increase your mesalamine to higher dosage.

When do you go back for biopsies results?

q
Posted 7/31/2018 2:22 AM (GMT 0)

quincy said...
Doesn't sound like a healing pattern of UC, but hopefully, the doc will increase your mesalamine to higher dosage.

When do you go back for biopsies results?

q

Hi Quincy, My biopsy results will be coming in a weeks time. My doctor is confident that he did not see any abnormal tissue but he is suspecting of infectious causes. He ordered CMV test along with routine biopsies.
Posted 7/31/2018 6:21 PM (GMT 0)
Looking forward to the results.
Hope something can be pinpointed so that treatment will be more helpful.

q
Posted 8/3/2018 12:31 PM (GMT 0)
I have another question. My GI told inflamation is in mid sigmoid & above and he did not see any inflamation in rectum and lower sigmoid. But I'm still bleeding with mucus and blood. Is it normal to have bleeding without rectal inflamation? My assumption is only rectal inflammation cause bleeding. How to tell if the bleeding is from rectum or high up?
Posted 8/3/2018 1:47 PM (GMT 0)
Bleeding occurs where ever there is bad inflammation and/or ulceration. NOT limited to rectal-bleeding, yes, you can get bleeding from higher-up.

The ulcers in UC are very small and individually produce small drops of blood. When you have many ulcers, the amount of blood adds up to something we can see in our stool.

Inflamed intestinal tissue is engorged and swollen due to high amounts of blood. Inflamed tissue is fragile and leaks blood, especially when pressure is put on it.
Posted 8/6/2018 12:53 PM (GMT 0)
Hi Folks,

I just got my biopsy results. Can anyone tell me if i've pancolitis by looking at the result below. Mine is always left sided colitis and this is the first time they have ever taken biopsy from right colon.

Ileum: Sections show superficial small bowel mucosal fragments with minimal increase in chronic inflammatory cells in lamina proportia. The villous architecture is normal.There is no conspicious acute inflammation or ulcerations in the multiple levels examined. There is no evidense of dysplasia or malignancy.

Right Colon: Sections show fragments of colonic mucosa showing edema and mildly increased inflammatory infiltrate in the lamina proportia comprising of lymphocytes and few neutrophils. There is no ulceration or architectural distortion. There is no cryptisis or crypt abscess seen. No evidense of dysplasia.

Left colon: Sections show colonic mucosa with mild to moderate patchy dense lymphocytic infiltrate in the lamina prportia. There is mild architectural distortion. Focal cryptitis and crypt abscess are identified. No evidense of dysplasia.
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