Is Mesalamine not effective for my ulcerative colitis?

Question

Hello doctor,

I am 34 and was diagnosed with ulcerative colitis last year after a colonoscopy showed continuous inflammation up to the sigmoid colon. I am on Mesalamine and probiotics, but I still get loose stools and mild bleeding sometimes.

Does that mean my medication is not working properly, or could it be diet-related?
How long does it usually take for the colon lining to heal completely?
Also, are dairy and spicy foods really triggers or is it different for each person?
My recent C-reactive protein is slightly raised at 8 mg/L. Does that mean a flare-up?

I am trying to avoid steroids if possible.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Yes, your current symptoms likely mean your Mesalamine dose or formulation needs adjusting. The mildly raised C-reactive protein (8 mg/L) suggests ongoing low-grade inflammation. Complete healing of the colon lining can take months. Dietary triggers are highly individual; dairy and spicy foods are common but not universal. A food diary can help identify yours.

The possible causes can be:

Persistent active inflammation from ulcerative colitis (ulcerative colitis). ·
Insufficient medication dose or formulation for the extent of disease (proctosigmoiditis).
Potential non-adherence to medication.
Dietary triggers (individual-specific). ·
Stress or concurrent infection.

I would suggest the following investigation:

Stool test: Fecal calprotectin (more specific for gut inflammation than C-reactive protein).
Repeat colonoscopy with biopsies: Gold standard to assess mucosal healing and extent of disease.
Blood tests: Repeat C-reactive protein, full blood count, liver function tests, and iron studies (to check for anemia).

The other conditions that need to be ruled out include:

Infectious colitis (for example, Clostridioides difficile, cytomegalovirus).
Irritable bowel syndrome overlaps with quiescent ulcerative colitis (ulcerative colitis).
Crohn's disease (though colonoscopy suggested ulcerative colitis).
Microscopic colitis.
Bile acid malabsorption.

Based on the available information, the most probable diagnosis is ulcerative proctosigmoiditis with mild to moderate active disease that is not optimally controlled on the current Mesalamine regimen.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.