Pancolitis flares are tricky to treat with topical meds. 'Topical' meds can be administered orally or rectally in that the oral drugs are just coated with a polymer which breaks down at pH levels around 6 (illeum) and >7 (colon). I take Apriso, for example, which is an anti-inflammatory capsule which breaks down in the stomach and releases tiny beads; the small polymer (different than capsule) coated beads have mesalamine. When they reach the colon the polymer dissolves and they're designed to actually swell when reaching those colon pH levels. So even though I take it orally, it's topically applied to the colon.
If one has severe pancolitis then those polymer coatings are tricky because the mucosal layer of the colon might not allow the medication to release where you need it (pH might be off there). Thus, you might just need a 'systemic', oral med (med abosrbed in stomach and goes throughout your system and thus likely has more side effects in other body parts).
Rectal meds can be 'systemic' acting as the medication does absorb into your blood stream through the colon. I always got bad headaches using rectal mesalamines like Rowasa. It burned, painful, and gave me a sick headache, flu-like, feeling when my colon was severely ulcerated while the Apriso design is more topically allied, through its design.
That make sense?
Hopefully doc reads all about
that and listens to drug reps educate him/her on the new medications and treatments. Plus he/she should be reading their periodicals, continuously updating themselves. Some more
open to things like FMT and other.
Choosing a good GI is key; one that isn't stuck with the knowledge they graduated. My doctor used to tell me about
a medication and ask me if I was interested in it (he realized I researched and read all the literature on side effects, efficacy, interactions plus knew my body very well).
Rectally applied meds only reach so far; depends on how empty your colon is and how many yoga positions you know. Agree with gary about
topicals being the preferred and just know topical just isn't via rectum. My sister gets her steriod enemas compounded to not suffer the side effects of orals but she doesn't have pancolitis like me. She has the drugs tailored to her tolerance (her brother's a doctor so that helps).
I tried every enema I could (plus "natural" methods; never did FMT). But just so I avoid any debating I agree a 'systemic' is a med which travels throughout your system and so would likely have more side effects (plain prednisone, Remicade, Imuran, aspirin...). But just because a med is put in your rectum does not mean it is only topical; it's likely more targeted and preferred and less travels into the whole body than something absorbed in the stomach or small intestine.
Post Edited (Burli) : 2/21/2015 12:55:05 PM (GMT-7)