mesalamine foam and enema

I'd say pancolitis, unless they prove you have an infection in addition to UC (a c-diff on top of your UC).

Your Ileum has immune cells active in the shallow tissue (lamina proportia) of the large intestine (often lymphocytes). Those cells are attacking something beneath the protective mucosa barrier, into the tissue. This is characteristic of UC inflammation.

Your right colon has edema (reddening), much like a sunburn on your skin the colon was an obvious coloration and that's suggestive of very mild inflammation. Much like the Ileum, there was also immune cells attacking something shallow within the tissue.

Your left colon shows the most severe involvement of UC inflammation. All typical stuff, distortion (chronic architectural changes), issues with crypts being weird, immune cells in the tissue, etc.

I'm no doctor, always confirm with yours. Like I wouldn't be at all surprised to hear mild-severity pancolitis to me. The presence/absence of ulcers is irrelevant and not necessary to say.

Whatever is happening in the TI and right side is fairly new inflammation and very mild in severity, it has yet to make permanent architectural-changes (nothing chronic stated). To make it clear, architectural changes are nothing at all to be afraid of, anything that causes symptoms, or anything you should strive to avoid.

What are architectural changes then? They're something important to a pathologist who looks at your biopsies and allows him/her to classify those slides as being characteristic or suggestive of a specific disease. It's a key identifier. Sorta like my driver's license stating my height, hair color, eye color, weight, date of birth, and address: all identifiers things that help identify me as a licensed driver (and qualify me for buying booze at the bar, a bonus, haha). Similarly, architectural changes classify you as an IBD/UC patient (which might make me/you want to buy booze at a bar...ugh).

What's all that medical jargon good for then? Good to know the extent and severity of inflammation as that directly impacts our quality of life and causes symptoms. The TI barely has any involvement at all. The right-side has very, very mild involvement (more than the TI but nothing major). The left side is by far the most active section in your report (as is always the case with UC patients). So, your left side is causing most if not all of your troubles at the moment. Treat that left-side well to resolve your most troubling symptoms. Of course, the right side and TI need treatment as well but are generally doing well.

If it is confirmed as a pancolitis at your next appointment, then your first question should be: what should you/I do to treat this fully (prudent to maybe consider immunomodulators or biologics?)? What you have right now is pretty mild, but you want to catch this early, treat it sufficiently, and keep it from getting worse. One key truth with UC is that the severity of inflammation is a lot more important then the extent of inflammation is. Mild pancolitis cases do much, much better than severe proctitis cases do (better quality of life, less symptoms, etc.). As long as you're well managed and in a remission, then whether you have a pancolitis or a proctitis should be pretty much irrelevant. Yes, CRC risk is higher for pancolitis patients, but unless you've had UC for multiple decades then that is also equally irrelevant. Just make sure to get annual CRC screenings beginning at 8-10 years after your diagnosis. And remember that only 3-5% of us ultimately get a CRC, it's hardly something to loose sleep over.

Post Edited (iPoop) : 8/6/2018 9:58:29 AM (GMT-6)

Quincy, it says simply "left-side biopsy" without indicating exactly where: Sigmoid, rectum, etc.

Hi Quincy,

Biopsies include rectum & Sigmoid as well but they have kept all samples from left side in one container.

Hi Quincy,

Yes pathology is consistent with moderate UC. I guess they are taking the biopsy from the area wherever the inflamation is as it is not a screening colonoscopy which they normally do after 8-10 years of UC. I've UC for 5 years now.

I Finally had discussion with my GI yesterday. He did say it is pancolitis but right side not worrisome, Only left side is the main problem. He thinks my desending colon not healed yet bcz i switched to foam from enema two months back and that could be the reason. So,he wants me to switch back to enemas and try for another month and if bleeding still persists he is going to put me on prednisone.

Hi Quincy,

My GI did not advice to increase oral meds but i myslef increased to 3.6 gm. I see the tablet is coming out as whole atleast once a day since then. So, i'm reconsidering my GI's advice. I am using 500mg suppositories instead of foam in the morning.

One pill is no big deal. If it was cracked it's fine. But you could consider another brand.

Are you taking it with or without food?

q

There's a few different mechanisms to deliver mesalamine to the large intestine. Most are equivalent, and a doctor or pharmacist will tell you there is little to no difference between them. Anecdotally here, some report that one works better for them than another. I've never seen a head-to-head scientific study showing how effective the various formulations are against each other.

It really depends on the medication, most mesalamines come with a slight variation of a PH-sensitive coating made of a plastic (MMX/Eudragit coating in their literature) that's delayed-release. Essentially, our digestive system has areas of known PH acidity and base, food is held in areas at those PHs for known periods of time to digest. These coatings are designed to begin dissolving when exposed to a specific PH for a certain length of time. They start releaseing at the ileum (where the small and large intestines join).

Pentasa is different in coating from the others. Pentasa uses a ethylcellulose semi-permeable membrane. Described in more detail below. Key take away is the release point is from duodenum (the first part of the small intestine immediately beyond the stomach) to the rectum. Larger dispersal area, much of which is irrelevant to UC patients.

www.ncbi.nlm.nih.gov said...
Time dependent formulations
Pentasa® (Ferring Pharmaceuticals, Copenhagen, Denmark) adopts an alternative method of drug delivery consisting of microspheres of mesalazine encapsulated within an ethylcellulose semi-permeable membrane. This structure allows time and moisture dependent release of the active drug, independent of the luminal pH. Mesalazine is theoretically distributed gradually throughout the gastrointestinal tract from the duodenum to the rectum[22]. This in turn may be of therapeutic value in patients with small bowel Crohn’s disease[23]. In ulcerative colitis, the efficacy of Pentasa® has been demonstrated in multiple studies, including one randomised control trial where 64% of patients maintained remission after 12 mo of Pentasa® 4 g/d compared with 38% of patient who received placebo (P = 0.0004)[24].

Source: /www.ncbi.nlm.nih.gov/pmc/articles/PMC4635154/

No harm.

Hemmeroids would be very bright red blood color. Uc bleeding from above the rectum is dark red to a dark red wine coloration, if you're seeing that then rule our hemmeroids for sure.

It can be difficult to distinguish uc bleeding and hemorrhoids at times. That's when endoscopy or inflammation tests (fcp stool test or crp blood test) might come in handy.