Welcome to the forum. I would push to get a prescript
ion for the mesalamine retention enemas, they should reach up to the splenic flexure. Use those in combination with the 4 lialda a day.
The Bx report showed “active colitis with mild permanent changes” in the rectum and sigmoid and everything else was normal.
The permanent changes plant you firmly within the Inflammatory Bowel Diseases camp. The continuous rectum and sigmoid inflammation, and then stop puts you firmly in the UC camp, more specifically proctosimoiditis (procto=rectum, sigmoid colon, itis=inflammation) extent camp.
I had some inflammation up near the splenic flexure that wasn’t there before. The Bx report showed chronic active colitis at 60cm, chronic inactive colitis in the left colon and sigmoid, and patchy chronic inflammation in the rectum with “regenerative features”. It lists cryptitis, crypt distortion, crypt abscesses, and increased inflammatory cells in the lamina propria at the 60cm area. The conclusion says “findings are compatible with IBD.”
It's not uncommon to have proctosigmoiditis spread upward, mine did from an initial 14 cms to 40 cms or so.
Active colitis means there is inflammation visible there today.
Inactive colitis means that there are signs of past inflammation, but that area is currently inflammation-free.
"It lists cryptitis, crypt distortion, crypt abscesses, and increased inflammatory cells in the lamina propria at the 60cm area." This is classic UC, crypt cell changes are very common and diagnostically important to UC. The inflammation is shallow, only within the lamina propria layer as is typical of an UC.
What's a bit not like UC:
1.) Patchy inflammation is rather curious, as UC is a continuous inflammation illness.
2.) You have a big skip lesion (an isolated inflamed area surrounded by normal, not-inflamed tissue).
It is possible your medication is healing you partially but not fully on both #1 and #2. You sound solidly UC otherwise. I'd ask your doctor if you're still UC or if you are now Crohn's-Colitis or Indeterminate-Colitis due to #1 and #2. I would expect you are still an UC patient.