Oral meds for proctitis?

You were still in a flare...not in a flare again after 3 nights.

What exactly are your symptoms? And whether you have proctitis or pancolitis...oral 5ASA meds should be part of the med regimen.

q

The most successful treatment for Proctitis is rectal-route meds like suppositories or enemas (goes straight to the source and is effective). Some doctors do switch Proctitis patients to orals during a remission, mostly due to compliance worries with maintenance rectals.

The orals are designed to release medication over the roughly 5 foot length of the large intestine, and your rectum is the last 6-8 inches of that area. By the time your oral pills reach your rectum, they're mostly dissolved and active medicine mostly dispersed. The treatment of the rectum via oral pills seems to be inconsistent and incomplete. Maybe very mild proctitis cases are okay with it, but I'd think it's less effective than rectals.

nakamura1967 said...
You need oral meds and rectal meds in our experience. I would say for proctitis the rectal meds are essential to treat the disease and the oral to stop it progressing.

I was under the impression that, as an autoimmune disorder, if chronic proctitis is going to progress there’s no stopping it. But perhaps oral meds could slow down progression. I need to do some more research.

what quincy says x a bunch -


TT

5-asa’s have very few side effects. Trust me get on top of it now or you will end up on much more serious drugs.
Good luck

Missing Key Value : en-US, 736

Hi, just wanted to come back on a topic you mentioned above. I had pancololitis when first diagnosed, it later evolved into proctitis as the various medications could not fully control it. Having had multiple scopes (5) I can confirm that 1. The inflammation was always worst in the rectum and 2. The worse my symptoms, the further up the descending colon the inflammation had spread. For the vast majority of UCers, inflammation starts in the rectum and spreads upwards as the flare progresses. Keeping mild inflammation in the rectum under control can and does prevent it from spreading. I use immunomodulators but the last time I started to flare i used enemas to get back into remission. And we know for sure that i have pancolitis potential.

I hope it's 1.2g twice daily.
q

I am now on a oral/enema mesalamine combo, having started in early August and it has been a game changer. I started with proctitis and my condition evolved to left-sided colitis based on my recent scope in August. I had not been on any oral meds for at least 10 years, which is probably why it got worse and, I admit, was intermittent with my enemas, at times, but took it more than not. I was in a worsening flare, worst compared to my previous symptoms which were very mild. We talked about biologics after my scope but my GI wanted to try me on this combo first since he didn’t see my symptoms being beyond mild-moderate. I was still only going 1-2 x per day but with bloody mucus mostly and some formed stool. Knock on wood, it is working wonderfully. I have no symptoms right now. Try it out. Hope it helps you too.

Glad the oral meds are working! My doctor’s policy is that you wait to taper recitals until you have had 2 weeks of no bleeding. Then start every other day for at least two more weeks before reducing again.

Update: haven’t tapered rectals yet. I’ve been *almost* symptom free for the past two months on combo therapy. Two mostly solid BMs a day, three max, no urgency, no mucus, no D or C. Still intermittent blood though. Two to three times a week. Small amounts on stool. Used a hemorrhoid cream the last two weeks nightly in case it was hemmies or a fissure. Seemed to relax that symptom, then I got some mucus with blood last night (ugh). None this morning though. Mild abdominal uneasiness and pressure. What a frustrating disease this is.

For treatment, I’m looking at going ahead with Canasa in the morning and Rowasa in the evening and staying on 3.6g orals. I initially avoided the supps due to expense (150$ for 30 days) but am desperate enough to try now. Anyone else have experience with high levels of ASA rectals to kick stubborn proctitis into remission? I’m open to suggestions. I thought about cortenemas too though last time I tried them for three nights and they seemed to make me worse. Maybe I wasn’t patient enough with them.

Also: my GI is retiring so I’m waiting to get in with a new one. He’s convinced I’ve still got limited proctitis based on lab results and symptoms. My guess is there’s a patch of inflammation in there that is very stubborn. I do want to get a colonoscopy next year to get some certainty though I may be waiting a while considering the only place to get on here is the hospital and they’re limiting the procedures due to the Covid situation.

Hey q,

Thanks for the encouraging words. The combo therapy is definitely working... It’s been two months and I get the feeling I’m very slowly improving with the occasional hiccups. The blood from a few nights ago was around the stool (with mucus) and I’m guessing a teaspoon or less? None in the toilet. Whenever I bleed it’s only in the stool and/or on the surface of it. After seeing it a few nights ago I’ve had almost none in the last few nights, save for a teeny bit once. Seems like bleeding is the absolute last thing to hang on while everything else subsides. And when I saw hang on I mean small amounts on a weekly basis for moooooooonths.

Hopefully I can get that solid month of no problems so I can try a taper again. I think I’m going to alternate Canasa supps on off nights considering I’ve been on Rowasa for over a year. I’m freaked about taking the taper plunge considering things are working pretty well but I like the idea of having something to increase into when needed. The dream is to get the rectals down to a few times a week. Crossing fingers.

Been on Rowasa nightly for almost a year and a half... still getting good, if uneven results.

Had an appt. with a new GI doc today. He was insistent on doing a scope in a month or so. Any suggestions on what to ask for? The main request I heard from y’all to mention is “biopsies throughout.” Just want to make sure surveillance is thorough. Also, he mentioned possibly trying Humira to knock the proctitis out and I told him I want to max out rectal meds before any step-ups. Might go to a steroid suppository in the morning in addition to the nightly rowasa for a bit and see how that goes. Once I get scoped we’ll talk it over... I’ve got GERD as well so the doc is doing an endoscope too! Fun fun!