New to the forum

welcome PooPlayer

i would advise staying at the 7.5 pred for now, and if symptoms continue, upping it to 10mg - no sense in winding up in a full blown flare if you can help it -

Hopefully all is good. Staying on pred while taking Imuran for 6 weeks is good, because it should just now be working. That you responded to the combination of all 3 drugs is also good. Folks who don't respond to pred have more complex cases often involving co-infections.

I don't count a flare as over if the only thing managing it is pred. Some people like to say a new flare starts when they taper, but this is semantics. I think the original flare was down to pre-clinical levels, and heats up again when the pred is gone.

The best situation is that the pred has allowed the Aspiro and Imuran to get a good foothold. You may have some uptick in symptoms when you taper the pred, and it may help to finish the taper very slowly. But if Aspiro and Imuran are working, there should be slow continued improvement in symptoms.

It may plateau. In my case I was on Lialda only, and at 18 months it had cleared my right and transverse colon and the top of the left colon, but was not reaching further. Since you are also on Imuran, which works systemically through blood, hopefully it will help clear all the way.

The last few inches may require rectal medications, and you should ask about these if there is a lot of increase in urgency or significant amount of red blood that is persistent.

Some foods are anti-inflammatory, (tumeric is a good example) but most food for many people seems to relate to symptoms - not underlying inflammation. For example beans does not cause inflammation, but it is inconvenient to have extra gas when there is D and mucus. Likewise, fiber gives bulk, and it is more convenient to have low-residue when having many BM.

The flare is associated with dysbiosis of the gut microbes, and you may experience some temporary intolerance of gluten or lactose. I had to stop gluten for a number of months, but now I eat bread when I want. Probiotics may be very useful in preserving your ability to eat what you want.

More than one drink of alcohol seem to give me (and others) a lot of symptoms, but not other-others.

Some IBD people also get IBS. IF the flare never quite ends but the blood is gone, ask about a trial of IBS medication for the remaining symptoms.

A lot of complicated and interrelated possibilities. Keep learning and thinking.

good luck

"I'm noticing some flare symptoms returning such as loose stool and some stomach pain but I'm hoping it's all just part of the taper process and not the beginning of a full blown flare." Dropping the prednisone dose might upset your system for 2-3 days and preduce worse symptoms temporarily (more bms, looser bms, even a hint of blood) but you should bounce back quickly. If you do not improve and continue to regress as you taper then that's a huge waving red flag that there's trouble ahead and you'll flare if you continue tapering. You go back to your last safe pred dose and call your gasteroenterologist when that happens. As you must adjust your maintenance medications before continuing that taper. Or in your case just wait longer for the imuran to work before continuing your taper.

"maybe when I'm completely off of pred, I'll be more sensitive to certain foods?" i eat without diet modifications as i could never find specific foods that upset my uc symptoms. Some have trouble foods and choose to exclude those foods. Diet modification is super individual, what is one's miracle makes no difference to another, and can even make another's symptoms much worse. A food diary helps, write down what you ate, your symptoms the next morning, and look for correlations.

IamCurious said...

DBwithUC said...
Some foods are anti-inflammatory, (tumeric is a good example) but most food for many people seems to relate to symptoms - not underlying inflammation.

I disagree. If I indulge in a Starbucks hot cocoa at lunchtime then for sure I will have bloody diarrhea that evening or the next day at the latest. Bleeding may indicate more than just symptoms but actual inflammation. And there are members here who have been bleeding for years that only stopped when they went on a diet that avoided gluten. I suspect that gluten can cause inflammation in some people.

well, you provide an exception. this is not the basis for disagreement with what I said, because I was careful to acknowledge some exceptions - and specifically said "many people" and "most food" - the distinction of idiosyncratic/anecdote and nomothetic/average results supported by research is important to successful and clear conversation on these issues.

I have no reason to doubt hot coca increases your motility. I have no doubt that increases motility causes ulcers or friable tissue to bleed. But I do doubt that the heat or the coca caused inflammation in less than 12 hours unless there is something strong like an allergic reaction involved.

So "this" food gives "you" symptoms that may indicate in increase in inflammation already present. This is a very poor basis to day you disagree with a statement that "most" food for "many" people is "seemingly" more related to symptoms than underlying inflammation.

Words matter. Think about it.

DBwithUC said...
Words matter. Think about it.

I never said all foods trigger inflammation but some foods do. That is why for the past 6 years I have advocated keeping a food diary to isolate food that triggers inflammation and symptoms. Starting with gluten and dairy since they are the most common triggers. But other foods such as cruciferous vegetables can cause problems for some people, hence the food diary.

Here is some scientific research proving that gluten can cause inflammation. I have seen other studies indicating similar results for dairy.

/www.ncbi.nlm.nih.gov/pubmed/19332085/
Wheat germ agglutinin (WGA) is a plant protein that binds specifically to sugars expressed, among many others, by human gastrointestinal epithelial and immune cells. WGA is a toxic compound and an anti-nutritional factor, but recent works have shown that it may have potential as an anti-tumor drug and as a carrier for oral drugs. To quantitate the toxicity threshold for WGA on normal epithelial cells we previously investigated the effects of the lectin on differentiated Caco2 cells, and showed that in the micromolar range of concentrations WGA could alter the integrity of the epithelium layer and increase its permeability to both mannitol and dextran. WGA was shown to be uptaken by Caco2 cells and only approximately 0.1% molecules were observed to cross the epithelium layer by transcytosis.

Here we show that at nanomolar concentrations WGA is unexpectedly bioactive on immune cells. The supernatants of WGA-stimulated peripheral blood mononuclear cells (PBMC) can alter the integrity of the epithelium layer when administered to the basolateral side of differentiated Caco2 cells and the effects can be partially inhibited by monoclonal antibodies against IL1, IL6 and IL8. At nanomolar concentrations WGA stimulates the synthesis of pro-inflammatory cytokines and thus the biological activity of WGA should be reconsidered by taking into account the effects of WGA on the immune system at the gastrointestinal interface. These results shed new light onto the molecular mechanisms underlying the onset of gastrointestinal disorders observed in vivo upon dietary intake of wheat-based foods.

Dr. Alessio Fasano, director of the Center for Celiac Research in Massachusetts found that gluten can stimulate a molecule in your gut called zonulin — a protein that triggers the opening of junctures between the cells in your gut lining.

In essence, it makes your gut more permeable, allowing food particles to escape into your bloodstream, causing inflammation, immune reactions and raising your risk of various autoimmune disorders. This is known as leaky gut syndrome, and you don’t have to have celiac disease to suffer the consequences of leaky gut.

Wheat germ agglutinin is another inflammatory, immune-disrupting protein found in wheat. Wheat germ agglutinin can provoke an inflammatory response in gut cells and disturb the natural immune barrier in the gut, making the gut more permeable to things that don’t belong in your blood.

And just the other day Imagardener2 posted this:

imagardener2 said...
From the article about a paper presented at the science conference:
"Scientists have discovered that a protein in wheat triggers the inflammation of chronic health conditions, such as multiple sclerosis, asthma and rheumatoid arthritis, and also contributes towards the development of non-coeliac gluten sensitivity.

With past studies commonly focusing on gluten and its impact on digestive health, this new research, presented at UEG Week 2016, turns the spotlight onto a different family of proteins found in wheat called amylase-trypsin inhibitors (ATIs). The study shows that the consumption of ATIs can lead to the development of inflammation in tissues beyond the gut, including the lymph nodes, kidneys, spleen and brain. Evidence suggests that ATIs can worsen the symptoms of rheumatoid arthritis, multiple sclerosis, asthma, lupus and non-alcoholic fatty liver disease, as well as inflammatory bowel disease."

Post Edited (IamCurious) : 1/1/2017 10:40:19 AM (GMT-7)

Regarding food and inflammation, I am sure some foods do contribute to inflammation at some times for some people, and maybe for most/many. My point would be that this would not likely be in a matter of hours, except with allergic reaction.

We can hardly acknowledge some nutrition (food or supplements) as anti-inflammatory, without implicitly acknowledging the inverse. Some foods may be pro-inflammatory, and which/when may depend on very individual dysbiosis of the gut microbes.

So I make three points:

A lot of unnecessary confusion follows failure to distinguish inflammation form symptoms. I think a lot of the failed communication between doctors and patients is because the former is talking about inflammation and the latter is talking about symptoms.

Second, a lot of the quick response (hours) to food is more likely symptoms (except with allergies). The onset of UC is not from one day to the next, nor is the entry into remission. The rate of increase/decrease for inflammation seems most often to be weeks not hours. If bleeding occurs over hours, most likely inflamed tissue ready to bleed had to be already present.

Third, one exception does not disprove a rule. It is very common for people to respond to a statement about average results for many people (which implies other results for some people) and say they disagree because of one example - and this is a rhetorical fallacy.