Q. Please suggest medicines to stop an ulcerative colitis flare-up.

Answered by
Dr. Ajeet Kumar Lohana
and medically reviewed by Dr. Sneha Kannan
This is a premium question & answer published on Aug 19, 2020

I’ve had uc for 30 years. One bad attack then remission for ten years til I had my second child. Then a few minor flares over the years. Was diagnosed bs sig moidoscopy then had colonoscopy that almost killed me. Haven’t had one since. Now I just had docicycline and amoxicillin /clav for tooth infection and now in flair. I have always been on a med like asacol. Lialda etc. now I’m on mesalamine. I need prednisone to put me in remission. It’s the only pill that works. I’m allergic to sulfur . My insurance is new I do not have a go doctor yet. Had a cat with double contrast showing some inflamation in rectum. Problem is how much pred can I start with for how long before taper. I don’t want bleeding to start. Right now it’s mucus pain and diarrhea / loose stools.

#

Hello. I welcome you to icliniq.

I feel very sorry to hear that you been through such a pretty bad time for that much years..

So first thing first, I am not convinced that you have acute flare of uc. This is because the cat is not a sensitive modality to detect bowel wall inflammation, and if we suppose if does, then the activity is only limited to rectum not whole of the colon. Flare and superinfectionn are two things to be considered whenever one has recurrence symptoms..The symptoms like diarrhea, bleeding, abdominal pain, and raised inflammatory markers are present in both.

Please mind you that steroids has role only in uc flare, it just can worsen infection so kind of contraindicated. The physician has to be very sure that it is flare rather infection whom we are treating before jumping to add steroids. I want you to have stool tests now and discuss with me once the reports are available.

Meanwhile I start you on some antibiotics for a week time I also want that you upload all your previous colonoscopic, sigmoidoscopic reports and current cat scan report as I can review the extent of disease, which would define the specific type and and dose of mesalmine, or consideration of the enma plus steroid enemas.


The Probable causes:

Superinfection
Flare uc
proctitis

Investigations to be done:

do upload all the investigations blood in particular
Stool for detail report
stool for calproctin
stool for ova and parasites
stool for c difficle antigen
Blood IHA foe entaameba histolytica

Regarding follow up:

follow up as advised


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