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Rowasa and Canasa - 2 GIs say they hit the same areas?!

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Ulcerative Colitis
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Posted 1/7/2015 10:35 PM (GMT 0)
So in the last 2 weeks I have been told by two different GIs that they are not a fan of Rowasa. They both told me in separate conversations that Canasa hits the same area of the colon and that Rowasa is more irritating and unless you stand on your head it doesn't get to your sigmoid.

Granted I always research this site and Rowasa has been very good to me, until this flare during which I can't retain it so I have been relying on Canasa until the the inflammation settles so I can get the enemas back into my regimen.

I've read a number of posts on the comparisons but was wondering if anyone has ever been told something like this? I do really respect my GI and he works with me on what works for my body which I'm learning isn't the norm (if there is a baseline) for this disease.

Thoughts are appreciated.

PS - I'm 27 weeks pregnant and was hit with a very fast flare (2nd flare - 1st was during last pregnancy). Upped my meds but seems like my hormones took control and nothing could calm it down. Landed in the hospital on New Years Day for IV steroids for 3 days. Now on 40 mg slow taper...doing much better. Trying to get the rectals back into the mix...
Posted 1/8/2015 1:45 AM (GMT 0)
I love Rowasa (well you know what I mean) it helps more than anything else. I can't use Canasa so I can't speak on that. I understand Rowasa hits higher--makes sense, liquid going around when lying on left side....where Canasa stays and melts at the very bottom. It makes perfect sense that Rowasa would hit more surface area.

I don't know with some of these GI's---I trust the people on this forum more. Different perspective when you have UC vs. theory. Just my 2 cents.
B
Posted 1/8/2015 2:20 AM (GMT 0)
I don't see how 1g and 4g of medicine can hit the same area. There is way more content in a rowasa. I've used both and I don't notice one to be extra-effective. I don't feel like anything works that well for me. I bet canasa treats about 1-2 inches maximum.
Posted 1/8/2015 10:40 AM (GMT 0)
I always thought canasa was far superior to mesalamine enemas in my case anyway. It may be less medicine but the mesalamine I agree may irritate the fragile colon walls, not sure if that is the case, but that is what I noticed sometimes when using them. I wish the canasa would reach higher though because I do have 30 cm. of inflammation when flaring. It may be that the mesalamine enemas are like a wash and when inserted clean up the lining of the colon so when you go in the morning that is what you see. Even though I have had this disease for almost 4 years now, I am still quite new to all this and just kind of acting like a scientist on the effects of both. I always thought that if only they could make the canasa longer than that might work then of course it would probably break in half on insertion.
Posted 1/8/2015 12:33 PM (GMT 0)
Rowasa and Canasa - 2 GIs say they hit the same areas?!

Exactly how far do they expect you to push that suppository lol?

The distance enema fluid travels is well established. I did a quick search of http://scholar.google.com and come up with the following study. I am sure there are many others. Print it and bring it to your next gi apt.

www.ncbi.nlm.nih.gov/pmc/articles/PMC1645811/
Posted 1/8/2015 12:33 PM (GMT 0)
Unless these 2 docs can quote a research paper that agrees with their opinion that Canasa is superior to Rowasa then that's what it is, their opinion.

My own opinion, based only on my UC and colon, is that Rowasa enemas reach higher because I can see the coating on much more stool distance/length than Canasa.

I think you should be the decider which works best for you.
Posted 1/8/2015 2:02 PM (GMT 0)
I think just about every doctor has their own opinions on things. I see it all the time. Sometimes those opinions fly in the face of facts. Doctors often make crap up as they go along and many patients just believe what they say because they figure this person is the doctor and must know what they are talking about. It is important for patients to be educated enough as to know when a doctor might be quoting known facts or merely giving their own opinions about something. I don't know about this particular case but I'm going to guess that through their experience with their patients these two doctors believe that Canasa works just as good or better than enemas so that led them to making these comments, even though it would seem to fly in the face of facts. There are some variables involved so they may be making a jump to a conclusion that is not medically and scientifically accurate.
Posted 1/8/2015 2:37 PM (GMT 0)
The doctor's statements are likely based on their observations. There is no way a suppository can reach as high as an enema, as there's no vehicle (liquid) to carry it above the rectum. Suppositories really mostly treat the perianal area, helping to relieve the spasms of the rectal sphincter that produce tenesmus and leakage. Enemas can treat the entire rectum and, if retained long enough, can treat at least part of the sigmoid.

My suspicion is that they find better results from canasa because more people are willing to actually use it. It's more comfortable, less messy and much less of a lifestyle change.

I can't share any personal experience because I don't tolerate any mesalamine by any route. My idiot new GI made a feeble attempt to switch me to Lialda this year. No thanks, I tolerate Balsalazide just fine and it's a lot less expensive!
Posted 1/8/2015 2:48 PM (GMT 0)
I appreciate everyone's input. I always take things like this with a grain of salt especially when someone isn't necessarily using the medicine them self. This is my first time using Canasa to treat a flare and not as an as needed maintenance.

Using the Rowasa when flaring badly was extremely uncomfortable (especially being so pregnant). I just hope that when/if I can add it back in that its not as bad. My body seems to be responding to the medicines differently being pregnant as well. In my last pregnancy Rowasa cleared things up within a few weeks...I was undiagnosed until 4 weeks after I gave birth. This time it seemed to make things worse.
Posted 1/11/2015 3:13 PM (GMT 0)
I would definitely ask them on what they are basing that conclusion. If it's anecdotal, then I would put my money on it being non-compliance with the enemas for a lot of patients. If it's based on data from a controlled study, then I think we'd all like to see that report.
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