Woud you change meds when in remission?

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LondonRed
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Date Joined Oct 2007
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   Posted 5/6/2009 2:08 PM (GMT -7)   
My GI is more concerned with some inflammation on the right side of my colon and with my Anemia (due to a a bleeding Ulcer) so has suggested I switched to 1gram of Pentasa twice a day.
 
I am currently in remission (although I have some mild inflammation showing on a scope) with no blood and no symptoms, would you switch too or stay with the Asacol in my position?
 
I also think Mesalazine can cause Peptic Ulcers in the body - anyone else had these problems?
 
All advice much appreciated.

Diagnosis Oct 07: Mild Crohn's Colitis. Also suffer from bleeding Peptic Ulcers. By the grace of God currently in remission. Current Medication: 800mg Asacol Tablets x 2 a day. VSL#3.


Valerie3
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Date Joined Feb 2009
Total Posts : 529
   Posted 5/6/2009 4:35 PM (GMT -7)   
Asacol and Pentasa are the same medication, they just release in different areas. I would stick with the Asacol if you have Crohn's Colitis like your signature says. I believe I have also read the ulcer thing, but I have not experienced it. Pentasa was not strong enough for me and I reacted badly to it anyway, so I was only on it for a short period of time.

chroniemomx2
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Date Joined Apr 2005
Total Posts : 2346
   Posted 5/7/2009 7:31 AM (GMT -7)   
If you have inflammation in your colon then you need to stay on the asacol.

ZenaWP
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Date Joined Aug 2007
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   Posted 5/7/2009 10:13 AM (GMT -7)   
London, I have switched meds while in my crohn's was in remission to try to get the arthritis under control better.  But, I only stopped one (6mp) and switched from one biological to another similar one.  I've thought about making more drastic changes, but am a little scared to mess with it too much since I'm in remission.  I understand it's a very hard decision to make...I'm in the same boat. 
Crohn's Disease, Acid Reflux/Gastritis, Hashimoto's Thyroiditis, Endometriosis, Arthritis, Depression/Anxiety.  Too many meds to list them all.  =) 


LondonRed
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Date Joined Oct 2007
Total Posts : 1184
   Posted 5/7/2009 11:12 AM (GMT -7)   
Pentasa also releases in the first part of the Colon better than Asacol and thats where my inflammation is. I am in two minds aarghhh!

Diagnosis Oct 07: Mild Crohn's Colitis. Also suffer from bleeding Peptic Ulcers. By the grace of God currently in remission. Current Medication: 800mg Asacol Tablets x 2 a day. VSL#3.


beave
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Date Joined Mar 2007
Total Posts : 1091
   Posted 5/7/2009 12:01 PM (GMT -7)   

LondonRed,

Pentasa does not release earlier in the colon than Asacol.  Both cover the entire colon, so there is no issue.  What you might be thinking is that Pentasa starts releasing earlier in the small intestine than does Asacol, which is true.  Pentasa releases throughout the entire small intestine and the entire colon, whereas Asacol releases at the end of the small intestine and through the entire colon.  So Pentasa would only be advantageous over Asacol if your problem area was early in the small intestine.  I see no benefit for you switching to Pentasa from Asacol.

Given that your problem area is in the right side of your colon, an option for you would be Entocort, which covers the terminal ileum and the ascending colon (the right side).

Lastly, it's quite unlikely that mesalazine medications are leading to your peptic ulcer problems, but it is a rare possibility.  There's really no way to know for sure whether you're that rare possibility.


LondonRed
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Date Joined Oct 2007
Total Posts : 1184
   Posted 5/7/2009 12:07 PM (GMT -7)   
Isn't Entocord a steroid? I have never needed to take steroids for my IBD. My GI said as Pentasa releases earlier then it is more guarenteed to hit the right side better, he said Asacol may not release as soon as it should with some peope depending on the bacteria in their colon.

I have had a capsule endoscopy and have no issues in my small bowel God willing.

I have only ever had an Ulcer since starting Mesalazine and I am allergic to NSAID's.
 
Thanks for that great post by the way.


Diagnosis Oct 07: Mild Crohn's Colitis. Also suffer from bleeding Peptic Ulcers. By the grace of God currently in remission. Current Medication: 800mg Asacol Tablets x 2 a day. VSL#3.


Valerie3
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Date Joined Feb 2009
Total Posts : 529
   Posted 5/7/2009 12:46 PM (GMT -7)   
If your doctor said that, I don't see any harm in trying. If you notice yourself getting worse though, make sure to switch back. Entocort is a steroid and is not good for a maintenance med, it's used if you're flaring. I am on it right now, and I will be weaned off of it once I go into remission. Good luck switching, I don't see any harm.

LondonRed
Veteran Member


Date Joined Oct 2007
Total Posts : 1184
   Posted 5/7/2009 1:03 PM (GMT -7)   
Steroids can also cause peptic ulcers!

Diagnosis Oct 07: Mild Crohn's Colitis. Also suffer from bleeding Peptic Ulcers. By the grace of God currently in remission. Current Medication: 800mg Asacol Tablets x 2 a day. VSL#3.


beave
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Date Joined Mar 2007
Total Posts : 1091
   Posted 5/7/2009 2:34 PM (GMT -7)   

Yes, Entocort is a steroid.  And yes, steroids like prednisone can contribute to peptic ulcer disease.  But Entocort is quite a bit different from prednisone.  Budesonide, which is the steroid in Entocort, has a high first pass metabolism, which means that most of it acts directly on the bowel and, compared to prednisone, does not act on the entire body.  This means it generally has far fewer side effects than prednisone.  For example, rates of peptic ulcer complications are far less with Entocort than with prednisone.

As for its use, it's true that it's generally used for a flair and not for maintenance.  However, it's a bit more complicated than that.   For example, you say you're in remission, yet you have inflammation in your right colon.  So, actually, you may be in *symptomatic* remission, but you're not in complete remission (defined as absence of symptoms PLUS absence of any inflammation).  For some people, that's good enough, and no change or addition to their medical treatment is needed.  For others, depending on the doctor and the patient's opinion, they may decide to add/change meds to try to knock down all inflammation, in order to get a handle on things before further damage is done to the intestinal wall.  So whether or not to change/add meds is up to you in consultation with your doctor; there is no clear cut right or wrong answer.

And what's more, studies are showing that Entocort can be used for short term treatment of flairs (a course of 8 weeks or so), and for use in maintaining remission for an additional few months.  It is considered safer for long-term use than prednisone.  So, really, you could think of it as falling somewhere between a short-term usage drug like prednisone and a long-term maintenance drug like Asacol, Pentasa, or imuran or 6mp.  Think of it as a medium term maintenance drug.

Now I'm not saying it's a must that you go on Entocort.  I'm simply saying it's a good option to consider if you decide you want further medical treatment of your inflammation.

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