enterocort enemas

aquilegia · Post by **aquilegia** » Sun Apr 03, 2011 1:08 pm

Has anyone tried taking the Enterocort via enema? My doctor said this is the best way to take it, but I didn't fancy it. He didn't tell me why it is better, but I guess all the Enterocort goes to the bowel that way and so it is more efficient.

Post by **tex** » Sun Apr 03, 2011 1:41 pm

That method of treatment is often recommended for ulcerative colitis, since UC is often constrained to the distal colon, but if the entire colon is affected, as is often the case with MC, (and part of the small intestine as well), the conventional, oral treatment is usually just as effective, (and probably more effective), and swallowing a few pills is certainly more convenient than using an enema, IMO.

If that were the best way to use budesonide, I doubt that you would be the first to post about it here, (no one else has ever had the enema version recommended by their GI specialist, that I'm aware of). Your doctor must think that your MC is limited to the lower section of your colon, but I doubt that is the case. MC is usually more pronounced in the proximal colon, (the part of the colon just below the small intestine), and treatment by means of an enema might not even reach that end of the colon.

Tex

sarkin · Post by **sarkin** » Sun Apr 03, 2011 5:07 pm

Very interesting - perhaps I'm lucky my MC was discovered at all, via flexible sigmoidoscopy. (Or perhaps it was more widespread?) I wonder whether it affects tissues in the the same areas consistently, or 'moves' around over time, perhaps more likely in a case where there's been a lengthy remission/recurrence? Just speculating...

Sara

hoosier1 · Post by **hoosier1** » Sun Apr 03, 2011 5:53 pm

That's ironic because I do feel somewhat better upon taking a mesalimine enema.

Post by **tex** » Sun Apr 03, 2011 6:26 pm

Rich,

Well, they work faster, and presumably one can safely administer a bigger dose, that way. If I recall correctly, you've speculated about having UC, in the past, but maybe your inflammation just happens to be more concentrated in the distal colon.

So was it Rowasa that you tried?

Tex

grannyh · Post by **grannyh** » Fri Apr 08, 2011 3:35 pm

Glad no one recommended that treatment for me! Let's see I was on entocort for 6 years.. lets say on average I was on two pills a day.. that would be 4380 enemas... I don't think so...LOL
Grannyh

Post by **tex** » Fri Apr 08, 2011 3:41 pm

Tex

natythingycolbery · Post by **natythingycolbery** » Fri Apr 08, 2011 4:05 pm

sarkin wrote:Very interesting - perhaps I'm lucky my MC was discovered at all, via flexible sigmoidoscopy.

Thats how mine was diagnosed

sarkin · Post by **sarkin** » Fri Apr 08, 2011 9:47 pm

natythingycolbery wrote:
sarkin wrote:Very interesting - perhaps I'm lucky my MC was discovered at all, via flexible sigmoidoscopy.
Thats how mine was diagnosed

That's interesting, too - I wonder whether there is any correlation between the area where the MC is discovered, the severity, or specific food intolerances. So many variables - but maybe in this area they'll find a clue about celiac vs. non-celiac gluten sensitivity.

Best in all things!

Sara

Gloria · Post by **Gloria** » Sat Apr 09, 2011 8:40 am

Grannyh wrote:Glad no one recommended that treatment for me! Let's see I was on entocort for 6 years.. lets say on average I was on two pills a day.. that would be 4380 enemas... I don't think so...LOL

Grannyh,
I just love your sense of humor.

Gloria

Post by **tex** » Sat Apr 09, 2011 9:06 am

Sara,

Neither the location of the inflammation, nor the lymphocyte count has been shown to have any correlation with the severity of symptoms with MC. Many GI docs mistakenly label a case with a low lymphocyte count as a "light case", but research evidence shows that they are wrong. GI docs have a consistent history of making incorrect assumptions, while continuing to deny obvious truths.

Here's why I made that comment about the typical distribution pattern of MC within the colon:

because both the density of intraepithelial lymphocytes and the thickness of the collagenous band tend to be patchy, it is essential to do multiple biopsies throughout the colon.19 Involvement of the left colon seems to be less intense than that of the right, and biopsy specimens from the left part miss about 10% of the cases. It is therefore recommended that tissue samples should be obtained from the transverse or ascending colon to deﬁnitely rule out collagenous colitis.

http://www.med.upenn.edu/gastro/documen ... olitis.pdf

Tex

sarkin · Post by **sarkin** » Sat Apr 09, 2011 9:27 am

Tex, that's interesting - thanks. It makes sense to me that there would be other factors that would determine severity from those that influence location. (Genes, luck, specific food intolerances, individual diet, pathogen exposure, hormones - pretty much everything.)

I'm really glad they found mine where they happened to look ;) I never would have found my way here if I still didn't have a diagnosis - I might have been wandering for years.

I wonder whether it's being found more now because it's being looked for a little more frequently. But i bet it's still a commonly missed diagnosis.

Regarding relying on incorrect assumptions - they just can't bring themselves to consider the experiential realities of patients as data. And it is, of course - and the most important data to the patient. I think of all those ulcer patients being told to eat bland foods and not getting better, while 'science' laughed off the guy who found the H. pylori cause for decades.

Funny that they leap to conclusions like "it just stands to reason" that lower lymphocyte counts would occur in 'lighter' disease cases... while refusing to consider other things that "stand to reason" - like what you put in your mouth has some relation to what goes on downstream.

And denying obvious truths, of course, is just silly ;)

Thanks again,

Sara

Post by **tex** » Sat Apr 09, 2011 10:22 am

Sara wrote:I wonder whether it's being found more now because it's being looked for a little more frequently. But i bet it's still a commonly missed diagnosis.

The diagnostic rate is way up because GI specialists are finally beginning to realize that taking biopsies is necessary for a diagnosis. Just a few years ago, they rarely took biopsies, because they considered MC to be a rare disease, so that was a self-fulfilling prophesy - you can't find MC, if you don't look for it. Consequently, as long as they refused to look for it, it remained "rare".

Tex

grannyh · Post by **grannyh** » Sat Apr 09, 2011 11:48 am

My cadiologist never heard of it.. asked me to spell it and still wondered what kind of disease it was... LOL Since I am merely a simple person and she is the one with the many degrees.. I said.. it is an auto immune disease.. and she brightened up and said OHHHH like she now knew everything about it...
grannyh

sarkin · Post by **sarkin** » Sat Apr 09, 2011 11:55 am

Interesting... I bet that holds double for MCE - not only do you have to do the biopsy, but the particular stain has to be used. So the evidence could be hiding 'in plain sight' even if someone's looking through a microscope.

I wonder whether it would be a reasonable practice to request the stain on all biopsies for possible MC and celiac patients.

In fairness, we never know what we know until we know it... and what all of used to know that turned out to be wrong sure gets in the way of seeing the right answer, even in plain sight! But it sure does help to be looking.

Sara