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Colorectal Diseases

Ulcerative colitis flare-ups

05/21/2007

Question:

Im a 31 year old female. I was diagnosed with Ulcerative colitis 3 years ago. Last year (2006), I had a flare up, I was on prednisone for 5 months with little effect. My doctor eventually started me on Azapress (immune suppression drug). This seemed to work. I am now back onto Asacol and have not taken Azapress for more than 2 months. However, the trouble seems to be starting all over again.

Before my flare up started last year, I broke out in a severe rash all over my body, another doctor prescribed Prednisone and took me off Asacol. The prednisone did not work properly to get rid of the rash and during this time, my ulcerative colitis flared up. (I was admitted to hospital for a week for steroid treatment every 6 hours and this also had little effect).

My questions are, why would prednisone not work efficiently for a rash and ulcerative colitis? Could there possibly be another underlying cause for the reason the Prednisone did not work? When I was diagnosed 3 years ago, prednisone therapy worked very well and I was feeling better within days. But last year it took 5 months and still was not very effective. I also have psoriasis, and during the prednisone treatments, the skin condition did not show any improvements. For the past year, I have suffered with various symptoms, body stiffness, fatigue, headaches, stiff neck, swollen neck glands, bladder infections etc. I have had so many tests - abdomen ultrasounds, xrays, urine tests, blood tests (kidney, thyroid, arthritis, liver, diabetes, CBC, CRP, Hormones). All the test results are normal. I dont know what else to do, I would appreciate any feedback or suggestions.

Thank you in advance for your response.

Answer:

The reason the prednisone is becoming less effective could be that you are developing refractory disease. Talk to the gastroenterologist who is managing your ulcerative colitis about all of your medical options- there are several drugs you have not mentioned that can be effective in certain patients. They should be discussed, as they may lead to control.

However, if your disease cannot be controlled, and the symptoms are unmanageable, you should know about your surgical options. It might be a good idea to talk to a colon and rectal surgeon now, before you need them emergently.

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Response by:

Janice Frederick Rafferty, MD Janice Frederick Rafferty, MD
Professor of Surgery
Chief of Colorectal Surgery Division
College of Medicine
University of Cincinnati