Sheila,
Many docs are reluctant to prescribe Entocort, because they consider it to be just as risky as the other corticosteroids. It's not, because only 10 to 15% of it is absorbed into the bloodstream - the rest goes into the lower third of the small intestine, and the colon, where it can do the most good. That's why they prescribe Asacol first, because they consider it to be a "safer" drug. Asacol is an old drug, so more docs are well acquainted with it - Entocort is newer, and, as I mentioned, most docs don't realize that it is far safer to use than traditional corticosteroids.
The biggest problem with Asacol, is that it contains lactose, so that many members here react to it, and it makes their D worse, rather than better. Also, long term use, (in a few cases), has been shown to be connected with pancreatitis, (inflammation of the pancreas). This is a possibility for any of the mesalamine-based meds, however. Most of the other mesalamine-based meds do not contain lactose, so they are better choices for treating someone with MC. Since most GI docs still do not realize that diet affects MC, they don't worry about ingredients in drugs. Even for the ones who do understand the connection between food-sensitivities and MC, most docs would consider Asacol to be a safe choice, because pharmaceutical grade lactose is supposed to be pure, (free of casein). Apparently, though, it is not, because many/most people on this board, who are sensitive to casein, cannot use drugs that contain lactose, without reacting.
Entocort is labeled for a recommended treatment period of up to 8 weeks, so most GI docs limit their prescription to that duration, even though the patient virtually always relapses after the treatment period ends, because that is not anywhere near long enough to allow healing of the gut. It's not even labeled for MC, of course, (no drug is) - it's only labeled for Crohn's disease. So many GI docs are overly-cautions, in order to cover their butts.
For all practical purposes, Asacol is just about as expensive as Entocort, which is ridiculous, for such an old drug, that's relatively cheap to manufacture.
Try Udi's bread for ready-made. If you bake your own, BreadsFromAnna, (Gluten Evolution), sells some great mixes, for various food sensitivities. Pamela's Products makes the best GF pancake mix, but be aware that it contains cultured buttermilk, and tapioca flour, to which some people are sensitive. Pamela's mix is even better than the mixes that contain wheat flour, IMO.
Sheila wrote:I have read posts from people who don't seem to have gotten any relief regardless of diet and drugs. Is MC sometimes refractory with any kind of treatment?
Well, it sometimes appears that way, but just like refractory celiacs, in virtually all such cases, they simply have undiscovered food-sensitivities that still remain in their diet. Either they are accidentally ingesting traces of a food that they believe they are avoiding, or there is one or more foods that they react to, that they are unaware of. It can be extremely difficult to track down all of the food sensitivities, in some cases, especially for individuals with double DQ genes.
Sometimes we seem to get worse, before we get better, after starting the diet, but if I were in your shoes, I would be suspicious of the Asacol, because a fairly significant percentage of members here, cannot tolerate it.
Tex
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