Why is my ulcerative colitis not responding to meds at 33?

Question

Hello doctor,

I am 33 and was diagnosed with ulcerative colitis last year after a colonoscopy showed left-sided inflammation. My CRP level is 22 mg/L, and my stool calprotectin level is 460 µg/g.

Even after three months of Mesalamine, I still have five to six loose stools daily with mild bleeding. So, my concerns are:

Does this mean I am not responding well to the treatment?
When should biologic medicines like Infliximab be considered, and are they safe for long-term use?
Also, can dietary changes or probiotics make a meaningful difference in flare control, or is medication usually the main way to manage this condition effectively?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I am really sorry you are going through this, as ulcerative colitis can be a very frustrating and exhausting condition to manage. The fact that you still have frequent loose stools and some bleeding after three months of Mesalamine suggests that your disease may not be fully controlled yet, which can happen in some patients.

A CRP (C-reactive protein) of 22 mg/L and stool calprotectin of 460 µg/g both indicate ongoing intestinal inflammation. In such cases, your doctor might consider adjusting your current Mesalamine dose, adding rectal formulations like enemas or suppositories if the inflammation is mainly left-sided, or introducing a short course of corticosteroids to bring the disease into remission more quickly.

If symptoms persist despite these steps, then escalation to advanced therapies such as biologic medications or small-molecule drugs becomes appropriate.

Biologic agents like Infliximab, Adalimumab, or Vedolizumab are designed to target specific inflammatory pathways and are often highly effective in patients who do not respond adequately to Mesalamine. These medications are generally considered safe for long-term use when monitored properly.

Regular blood tests and sometimes infection screening are needed to ensure your immune system remains balanced and that potential side effects are detected early. Many patients achieve long-term remission and even mucosal healing with biologics, which can greatly improve quality of life.

Regarding diet and probiotics, they can play a supportive but not usually primary role in controlling inflammation. While no single diet works for everyone, many people benefit from avoiding high-fat, processed foods and limiting dairy, caffeine, and insoluble fiber during flares.

A balanced, anti-inflammatory diet rich in lean proteins, well-cooked vegetables, and omega-3 fatty acids can help overall gut health. Some probiotics, such as those containing E.coli (Escherichia coli) Nissle 1917 or VSL#3 (live freeze-dried Lactic acid bacteria and Bifidobacteria), have shown modest benefits in maintaining remission, though results vary between individuals.

The most important thing is to stay in close contact with your gastroenterologist to adjust treatment early rather than waiting until symptoms worsen. With the right combination of medication, lifestyle management, and close monitoring, many people with ulcerative colitis can achieve long-term remission and live full, active lives.

I hope this helps.

Thank you.