Trying to Determine 5ASA's Efficacy

I can't tell whether 5ASA's are doing anything for me any longer. Like others here, both oral and rectal mesalamines did really well for a long time, but they don't seem to any longer (with one exception, which I'll get to). I have mild left-sided UC/proctitis.

I used Asacol for occasional flares for 20 years, and it worked well and quickly. Also used mesalamine enemas, with similar positive effect.

Today though, Delzicol upsets my stomach to the point of nausea and unwillingness to eat. Taking the Asacol out of the Delzicol delivery capsule didn't help. Plus, there were no real positive effects of either.

Liadal, up to 4.8g, also seemed to have little effect, and caused slight nausea over prolonged periods. It also caused gut "rumblings" and gassy discomfort.

I have a new supply of Colazal (generic), which I have not yet tried, as I am testing a different remedy (nicotine). I'll be posting an update about that when I have confirmed or discounted its ability to control symptoms.

When I use a mesalamine enema, it seems to do nothing for my condition, and in fact I wake in the morning with all sorts of gut "rumblings" and gas that are relieved when I get rid of the enema fluid. Again, no seeming positive effect on the UC.

However, I swear that the mesalamine suppositories really help my tenesmus when retained all night. Does it even seem possible that I would get positive effects from the supp, but negative results with all others? It can be so very confusing.

iPoop, Apriso has a much lower dose of mesalamine at the maximum daily dose than all of the other mesalamine-baed meds. Perhaps artvark has developed a small degree of mesalamine intolerance, but my guess is that it's just no longer effective for his (sorry if you're a her artvark) UC.

So anyway, artvark, how long have you been using the mesalamine enemas? (This time around, not in total for the time you've had UC.)

I'd probably give it a bit longer, then. It's not terribly unusual that the enemas cause extra gas and rumbling in the mornings. After all, there is some "foreign" liquid up in there, so to speak. Also, maybe this effect is worse this time around because your colon is more inflamed than it ever was before, so less of the liquid in the enema is being absorbed. I know that as my flare calmed, I noticed less and less of the enema fluid in my morning BMs.

And if the supps help, maybe use them in the morning and the enemas at night.

You could also explore steroid enemas -- maybe those would give better results.

And, I think you could consider using oral pred to gain remission, then go back to only using mesalamine-based meds, except you should continue to use them even when you're in remission.

Or, use mesalamine in conjunction with nicotine.

garylouisville said...
I'm surprised that when Asacol worked so well for you all of those years, when it was discontinued you tried everything except Asacol HD. Just an observation.

Denied by insurance.

Sometimes I just can't figure insurances out. Surely Asacol HD wasn't more expensive than Delzicol or lialda?

hateuc said...
What about adding Cortifoam to the mix for a boost?
B

Yep, and that's on my list for my next GI visit.

garylouisville said...
Sometimes I just can't figure insurances out. Surely Asacol HD wasn't more expensive than Delzicol or lialda?

Yea, I wasn't happy either, but I have not followed up with them. Maybe they denied it because it was following already-filled prescriptions for Delzicol and Liadla, and the insurance companies (much like my Dr.) seem to think all 5ASA's are created equal. We know better.

Haha soyman. Actually skydiving is quite fun, did it once a few years back and wow what a rush. If only it wasn't so darn expensive...

One thing I just noticed is that probiotics are as effective as mesalamine as maintenance therapy. So since the article examined remission and response rates, I'm guessing that they weren't similar for that?

And soystud, nope, never once have I wanted to skydive!

just curious fgirl - being conservative seems to be a general way of life, just like for me, being a dumbass creeps into most things I do and decisions I make -

I would have been surprised if you had said yes

I've been on the enemas nightly for well over a year. Now finally off of pred (after a 13 month go of it). Remi pulled me back from the abyss (a nasty flareup). Likely, consider a lower frequency of enemas, after I stay stable for a little while.

Enemas don't create gas, but the liquid can free existing gas bubbles from the mucus layer of the intestine. Sometimes I get real gassy as a result.

Statistically speaking, you have a higher chance of dying in a car accident than from a skydiving accident. If given the rare opportunity to do it, why not? I think it's worth it given the small risks.

According to the United States Parachuting Association, there are an estimated 3 million jumps per year, and the fatality count is only 21 (for 2010). That’s a 0.0007% chance of dying from a skydive, compared to a 0.0167% chance of dying in a car accident (based on driving 10,000 miles). In layman’s terms, you are about 24 times more likely to die in a car accident than in a skydiving one

We fly, we drive, we take pills and do many other things that are much riskier. Not everything that glitters is gold and not everything that is gold glitters. :D

Post Edited (StealthGuardian) : 2/12/2014 10:54:21 AM (GMT-7)

geez gary - up to now I've thought you have made some interesting decisions - BUT THIS !

holy crap, I would have been on her like splat on pavement !