Different Forms of Mesalamine for Areas of Colon

It sounds like you need to connect with a gastroenterologist experienced in treating IBD, especially if your ileo-cecal valve is problematic. Where and when were you diagnosed with UC? Did you get lab reports from your most recent colonoscopy that indicate the extent of your inflammation? The doctors you see should base your prescription(s) on clinical findings, not on guess-work! The most competent endoscopist would pass the C-scope to your terminal ileum to insure a correct diagnosis. / Old Hat (40+ yrs with left-sided UC; in remission taking Colazal)

Gotya! One of the medical experts' "known paradigms" for development of UC is prior infection by some types of organisms. (Mine likely from amebiasis.) Several yrs after UC DX I got a staph infection, likely facilitated by hydrocortisone immunosuppression; then dr. put me on Cipro to knock out the staph, which it did, but it made my UC inflammation much worse! RE mesalamine: sulfasalazine was the only 5-ASA available when I got DXed in 1980; didn't help. Nothing that succeeded it got me to remission with minimal side effects before Colazal, which was formulated especially to treat from descending colon downward. It's a large capsule with powder content, intended to cleave in the transverse colon. If you have ileo-cecal involvement, it's unlikely to help you-- probably Pentasa would be more effective for you. (Helps many patients with Crohn's colitis) I got no relief from Asacol, and later on researchers found that it requires colon pH (acidity) of level 7 or higher to process effectively! (Mine was level 6) Dipentum (1990s med, small capsules) relieved my inflammation but not fluid absorption; Colazal treats both! Apriso (ca. 2010+, large capsules) was originally intended for maintenance of remission; I can't tolerate it due to respiratory side effects; some docs now seem to RX it as an alternative to Lialda. Around 2013 some generic forms (Balsalazide disodium) of Colazal came to market, so it seems that most pharmas now dispense the generic made by Roxanne Labs because it's the cheapest. Your insurance might only pay for the generic; some members here on the forum take it in combo with Azathioprine and report that it works for them. (BTW, many of us need to beware of antibiotics making our UC worse!) / Old Hat (40+ years with left-sided UC; in remission taking Colazal)

The brandname Colazal has a pretty sturdy shell. (At least 1 of the generics doesn't, per comments made here some years back by UCers whose insurance would only cover generic.) Plus its contents are supposed to cleave via bacterial interaction in the transverse colon to project mesalamine into descending colon. According to past comments here RE Lialda, it doesn't help all pancolitis UCers to remission-- so your situation isn't unusual. But your doctors should have better insight toward guidance with these meds! Maybe you're hypersensitive to a secondary ingredient in Lialda so it doesn't work optimally for you. How long did you try Pentasa? I don't think that continuous switching between orals will solve your problem, based on previous member reports RE achieving remission via mesalamine. / Old Hat (40+ yrs with left-sided UC; in remission taking Colazal)

Old Hat said...
Gotya! One of the medical experts' "known paradigms" for development of UC is prior infection by some types of organisms. (Mine likely from amebiasis.) Several yrs after UC DX I got a staph infection, likely facilitated by hydrocortisone immunosuppression; then dr. put me on Cipro to knock out the staph, which it did, but it made my UC inflammation much worse! RE mesalamine: sulfasalazine was the only 5-ASA available when I got DXed in 1980; didn't help. Nothing that succeeded it got me to remission with minimal side effects before Colazal, which was formulated especially to treat from descending colon downward. It's a large capsule with powder content, intended to cleave in the transverse colon. If you have ileo-cecal involvement, it's unlikely to help you-- probably Pentasa would be more effective for you. (Helps many patients with Crohn's colitis) I got no relief from Asacol, and later on researchers found that it requires colon pH (acidity) of level 7 or higher to process effectively! (Mine was level 6) Dipentum (1990s med, small capsules) relieved my inflammation but not fluid absorption; Colazal treats both! Apriso (ca. 2010+, large capsules) was originally intended for maintenance of remission; I can't tolerate it due to respiratory side effects; some docs now seem to RX it as an alternative to Lialda. Around 2013 some generic forms (Balsalazide disodium) of Colazal came to market, so it seems that most pharmas now dispense the generic made by Roxanne Labs because it's the cheapest. Your insurance might only pay for the generic; some members here on the forum take it in combo with Azathioprine and report that it works for them. (BTW, many of us need to beware of antibiotics making our UC worse!) / Old Hat (40+ years with left-sided UC; in remission taking Colazal)

How is colon acidity tested? Is this a regular screening test one must have? Or just done to decide on the possible efficacy of a particular drug?

Seeker275-- Colon acidity level can be assessed in a way similar to occult blood: small stool sample applied directly to special test paper. It's not done routinely as far as I know, but mainly contributes to understanding of a colon's processing efficacy. / Old Hat (40+ yrs with left-sided UC; in remission taking Colazal)