Advice re: Mezavant please

Hello. I am new to this forum. But I'm not new to UC, unfortunately!

To give you a quick background, I was diagnosed with proctitis in 2009 and until 2015 it was controlled by Predsol suppositories during this period the only symptom was mucus.

Then about one year ago I had bleeding and underwent a colonoscopy to find rectal inflammation. The GI had me continue on the suppositories. By August 2015, the bleeding had become worse and another scope found the inflammation had spread to the Sigmoid. The GI prescribed Salofalk 1g enemas and quite quickly I was in remission.

However, 7 weeks ago the bleeding started again. Within 3 weeks of the bleeding starting I started to experience three symptoms never before experienced: watery stools; frequency (usually 3-4 times per day); and occasional cramps.

My GI did not want to do another scope. His rationale was that the scope in September 2015 showed the inflammation had spread and another scope would either confirm the inflammation was now worse or spread more. Either way he said the findings would not affect the next move, which was to use Mezavant.

I started Mezavant on Wednesday, 13 April. The first 6 days were an induction dose of 1 tablet for the first 3 days and then 2 tablets for the next 3 days. Then I went to 3 tablets (3.6g per day). My GI wants me to stay on 3 tablets for 2-3 weeks before going to 4 tablets per day.

He has also suggested that if Mezavant does not work (presumably within the next few weeks) then steroids and 6MP or Imuran would then be used.

I have two questions I was hoping to call on the experience of the group to answer:

1. I have been taking Mezavant for nearly two weeks (and for 7 days at the 3 tablet per day dose) but have noticed no improvement. How long generally before there is some noticeable improvement and would that improvement be gradual or reasonable sudden?

2. Is it typical to go immediately to steroids and immunosuppressants if one 5ASA doesn't work or would another 5ASA be worth trying?

Thanks for any advice.

Some people do report better/worse results with different mesalamines - each releases a little different. But it could take months to give each one a several week trial.

Make sure that you have not picked up a c-diff infection. That would be one reason for the pills not working.

While 6mp class of drugs is next step, some research suggests going straight to biologics may have better long run results.

It is hard to know what is best in an individual case.

could have had it, but it took off because of the prep - or could have caught it at the procedure center.

does seem odd D came after blood. often other way around