How to stop an ulcerative colitis flare-up?

Question

Hello doctor,

I have had ulcerative colitis for 30 years. I had one bad attack, then remission for ten years till I had my second child, and then a few minor flares over the years. I have diagnosed with sigmoidoscopy then had a colonoscopy that almost killed me. I have not had one since, and now I just had Doxycycline and Amoxicillin and Clavulanic acid (Augmentin) for tooth infection and now in flair. I have always been on medicines like Asacol (Mesalamine). I need Prednisone to put me in remission. It is the only pill that works. I am allergic to Sulfur. My insurance is new, and I did not have a go doctor yet. I had a computed tomography with double contrast showing some inflammation in the rectum. The problem is how much Prednisolone can I start with for how long before taper. I do not want to bleed, and right now, it is mucus pain and diarrhea, or loose stools.

Answer 1

Hello,

Welcome to icliniq.com.

I feel very sorry to hear that you have been through such a pretty bad time for that many years. So first thing first, I am not convinced that you have an acute flare of ulcerative colitis. This is because the computed tomography is not a sensitive modality to detect bowel wall inflammation. If we suppose it does, then the activity is only limited to the rectum, not the whole of the colon. Flare and superinfections 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 that steroids have a role only in ulcerative colitis flare. It just can worsen the infection, so contraindicated. The physician has to be very sure that it is a flare rather than an infection whom we are treating before jumping to add steroids. I want you to have stool tests now and discuss them 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 computed tomography scan report as I can review the extent of the disease, which would define the specific type and dose of Mesalamine (aminosalicylates).