newly diagnosed

Welcome to the forum shortwoman.

The colocort enema is a reasonable start, but it is not a long term solution. What is your DR's plan for when the colocort enema runs out? You cannot use this medicine indefinitely, and everyone with UC should have a maitenance medicine to support the remission they achieve with steroids (your colocort enema is a steroid).

An oral mesalamine would help get you into remission along with the colocort enemas. And then you should replace the colocort enema with a mesalamine enema. In fact, you could start using a mesalamine suppository right now in addition to the colocort enema. Use the enema at night and the suppository in the daytime.

The suppository is called Canasa and it can be expensive (depending on your insurance plan). But it may be worth it for a month to help you get better faster.

I remember I was sick for few weeks in March that would have started it. I was not taking any medication. Just cough and cold. I am concerned that my doctor has not discussed about any long term treatment plan besides call back in 3 weeks, and we will see how you do on enemas. Do I need to find another doctor?

Post Edited (shortwoman) : 5/18/2014 8:25:04 AM (GMT-6)

I would call back now, and talk to the nurse about your concerns regarding the lack of progress. I would ask for a doctor's appointment sooner than the one in 3 weeks. Whether you need to change DRs depends on how responsive your DR is to issues like this. Since you are new to this illness, you don't know what to expect, and your DR doesn't know what to expect out of your treatment either. You need to keep the DR informed.

It bothers me that your DR''s first approach is not along the lines of oral mesalamine + rectal mesalamine, which is widely reported in medical literature to be the best approach to treating distal UC. But perhaps s/he has a reason for choosing corticosteroid enemas. You should ask when you see the DR.

shortwoman, my first two gastros had that same approach. i actually didn't even know about oral meds until my 4th year of diagnosis. it was always enemas for flares. however, with this approach, my proctitis ended up spreading throughout my entire colon. knowing what i know now, i 100% which i would've start an oral med when i was first diagnosed.

docs usually give a mesalamine enema to start and then a steroid enema (like what you have) if the mesalamine doesn't work. i would still recommend starting on some sort of oral med so your whole colon is protected. that's the problem with this disease. it spreads quickly.

Oral mesalamines have very few side effects and none of them are health risks.

Given what you've said on this thread I do think you need to find another GI. But don't leave this current one until he has given you a prescription for both oral and rectal mesalamine.

He said that if enema does not work, he will give oral meds. I checked in with him after 10 days of enema and he prescribed enema for 14 more days. He said that oral meds have side effects and he will give me if only enema does not work. I will continue to take enema for 4-5 days more and call back by end of the next week. Does this sounds reasonable approach?

Thank you so much for all your help. I will call tomorrow.

Hi, somebody on this forum recently,and very kindly posted the following, I forgot who, but I think it will give you a better understanding of the drugs used to treat UC...the 5 ASA drugs mentioned contain Mesalamine which is what we were referring to....I take Pentasa, one of the 5 ASA drugs that contains Mesalamine.

5-ASAs are really the first line treatment for UC and are relatively weak drugs.

Since you are new to UC Ill give you a super quick run down of the main drugs we use so that you can be informed when you talk to your GI next:

1) 5-ASA: There are a bunch of different brands/types of 5-ASA drugs (mezavant, salofalk, etc) however they all contain the same active ingredient (namely, 5-ASA) and thus you can consider them to be the same drug. This compound works topically on the epithelial cells of the colon to reduce inflammation locally. I believe most UC patients take this drug in some capacity.

2) Immunomodulators: The main drugs in this category are azathioprine and mercaptopurine. They work by suppressing the production of B and T cells, which are the main cells that contribute to inflammation. These are pretty serious drugs that are often used in chemotherapy since they attack rapidly proliferating cells (in this case, the B and T cells). They can also have a lot of rare, but serious side effects (including cancers) so they should not be taken lightly. A very common azathioprine drug is called imuran. I suspect this is the drug your GI wants you to get next.

3) Corticosteroids: This mainly includes prednisone, prednisolone, and budesonide/Uceris. These drugs are infamous for their long list of scary side effects, however, their efficacy is tremendous. They can induce remission in as little as 24-48 hours. However, due to the risks, they are mostly used as short term solutions to induce immediate remission, and typically are not used long term (i.e. more than 2 months at a time). Budesonide/Uceris is a newer drug that is very similar to prednisone, but is more specific for the colon and therefore safer, so if you are from the States, you may want to try it as an alternative to prednisone.


4) Biologics: The main biologic drugs we have are TNF antibodies. These drugs bind to TNF (a pro-inflammatory cyctokine) and prevent it from inducing inflammation. Because they are antibodies they are 1) extremely expensive, and 2) have to taken either intravenously or by injection. However, they do have great efficacy for many people and can be taken long term. The main drugs in this category are Remicade (infliximab) and Humira (adalimumab). This is generally considered the last line of conventional treatment.

Thats really it in terms of the conventional treatments available right now, but there are a lot of great drugs that will be coming out in the next few years (vedolizumab, tofacitinib, etc). Additionally, there are a lot of other "non-conventional" treatments to considered as well (eg. fecal biotherapy, wild oil of oregano, probiotics, etc).