Scope today. Mild proctitis involvement

Scope day, flex-sig woot. New doc was concerned that I've been on so many meds and wanted me to taper off the mesalamines until I told him I was seeing blood thus the scope. Symptoms are 2 solid bms a day. Blood on tp when wiping off-and-on.

Report says : The musosa from the rectum to as far as the scope could be advanced (and visually beyond) appeared normal, with erythema, and blunted vasculature most prominent in the rectum and distal sigmoid to ~30cms. Areas more proximal had erythema, hyperermia (and scattered scarred appearance in the descending colon). Biopsies taken throughout.

Pretty minor inflammation (erythema/redness), see if anything beyond the rectum is actual inflammation when the biopsies come back *shrug.*

Prior to scope, doc said if it was bad, he wanted me off of remicade onto something else. Believe I dodged that bullet.

Sorry to hear you're seeing blood but I'm glad the scope showed it was very mild. Did you just start the enemas due to the blood or were you already on them for maintenance?

Just got a call with the biopsy results: "Practically-quiescent proctitis with only rare activity."

So I guess the erythema and hyperermia seen were not actual inflammation, but irritation from the prep. The doctor and I are both surprised, cuz the visual scope was suggestive of inflammation in rectum, sigmoid, descending into the transverse (at least looked abnormal). They said don't worry, pathologist's opinion takes precedence.

Sounds like they are treating it like a remission. Plan is to reduce the lialda by 1-pill a day, for a couple weeks, repeat until zero.

Good news, but puzzling on the blood on tp. I quizzed them on hemis, and anything else perianal seen, and they said nothing unusual. Try, wait, and watch, I guess!

That sounds pretty good John. I am happy for you!

Thanks everyone, both for the congrats and treatment thoughts. Certainly appreciate some different points of view on it, and some things to ponder in that regard.

This new doc wants to ultimately have me on only remicade; a point I strongly disagree with. I told him my prior GI tried this and I flared back then (ruined a nice 2.5 year remission, the best I've had so far), and I would not expect this time to be any different. So, I will definitely kick back on that thought by him. Right now, my remicade levels are in the 20's (exceptionally high), my Thiopurine Metabolites score is amazing (one of the best he has within his patients, it's working well for me).

I'm okay getting rid of the lialda, and doing nothing else for a number of months (keep remicade, 6mp, and nightly rowasa). Part of it is thinking that the generic lialda (zydus) is down to it's last bottle, new deductible kicks up on Jan 1st, 2019, and I don't want to refill it lol. If I need to refill, I'll likely ask for apriso or something with a discount card or just go basalazide disodium. As refilling the generic lialda will cost me multiple hundreds of dollars ($250, 350, I forget it was a lot). I'm cheap New Englander at heart lol.

Thinking see where I am at in a couple months. Next time I see the doc, in another 6-months or whatever, then we can see if reducing anything else makes any sense. Today, wait and see, I have no plans of reducing anything else. I do agree that 6MP is the villain in general.

Congrats on a good scope. I think I have heard you say something like symptoms don't always match the scope, so perhaps that is the case with your bleeding. I don't know if you have taken various mesalamines before, but if you end up adding one back in, perhaps it will end up working better. I thought that the mesalamines were supposed to be the biggest protectors agains cancer though?

Gotcha. My GI was puzzled I had so many symptoms with my more mild inflammation on the scope I had last year, so I thought it went both ways.

Great scope results!! You can always go back on a 5ASA oral whenever if needed.
What was his response regarding rectals?
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It sucks when you have a good doctor and they retire. I just went through that as well. I like my new guy so far, but not as much as my old doctor, who was amazing.