mesalamine rectal enema / Generic mfg. - LARVOL DELTA

A Case of Radiation Proctitis With Concern for Immune Checkpoint Inhibitor Colitis (ACG 2024) - "Case Description/ A 69-year-old female with past medical history of recurrent cervical cancer stage III T3 N0 M0 s/p chemoradiation and maintained on carboplatin, paclitaxel, and pembrolizumab, and diverticulosis presented with rectal bleeding...Sucralfate enemas and mesalamine suppositories were started with resolution of bleeding and transition to butyrate enemas as outpatient...Figure: Figure 1. Colonoscopy revealing friability and single ulcer in recto-sigmoid colon"

Checkpoint inhibition • Clinical • Cervical Cancer • Colorectal Cancer • Gastroenterology • Gastrointestinal Disorder • Immunology • Oncology • Solid Tumor

Common Variable Immunodeficiency Mimicking Inflammatory Bowel Disease (ACG 2024) - "He was given mesalamine enemas and steroids, but his symptoms continued...The patient is currently being managed with IVIG and dupilumab as an outpatient...B)Imaging from the patient's ileoscopy showing edema and erosion starting 2 cm from the stomal opening. It was otherwise a normal examined ileum without GI bleeding or polyps present."

Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Oncology • Primary Immunodeficiency

Active Ulcerative Colitis and Rectal Carcinoid Tumors: A Rare Occurrence (ACG 2024) - "She was prescribed oral mesalamine 2.4 g for one month, but given ongoing symptoms she was treated with a 6-week prednisone taper and mesalamine 4 g rectal enemas. After 6 months of refractory symptoms, she was started on induction-dosing of vedolizumab 300 mg (0,2,6 week intervals) and then every 8 weeks for maintenance...Figure: Figure 1. Rectal Carcinoid Tumor: Colonoscopic view of a 5 mm rectal polyp surrounded by friable granular proctitis, pathologically Grade 1, well-differentiated carcinoid with moderate active colitis and architectural distortion."

Carcinoid Tumor • Colorectal Cancer • Dermatology • Gastroenterology • Gastrointestinal Disorder • Immunology • Inflammatory Bowel Disease • Nicotine Addiction • Oncology • Pain • Solid Tumor • Tobacco Addiction • Ulcerative Colitis

Peroxide Perils: Unintended Colitis After Hydrogen Peroxide Administration for Vvaluation of a Rectovaginal Fistula (ACG 2024) - "She was discharged with mesalamine enemas and noted resolution in rectal bleeding within two weeks...Figure: Figure 1: Image A: Rectal mucosa with erythema and ulceration at 10 cm. Image B: Evidence of circumferential ulceration and friability up to 25 cm of the colon"

Constipation • Dermatology • Gastroenterology • Gastrointestinal Disorder • Immunology • Pain

Refractory Radiation Proctitis Toolkit: The Usual and Beyond! (ACG 2024) - "Use of compounded sucralfate enemas and mesalamine suppositories have their own value. It's unavailability and cost can be limiting factors. Figure: Persistent and hemorrhagic after 2 sessions of APC"

Anemia • Cardiovascular • CNS Disorders • Dyslipidemia • Genito-urinary Cancer • Hematological Disorders • Hypertension • Oncology • Prostate Cancer • Solid Tumor

Acute Ischemic Colitis Secondary to Inferior Mesenteric Arteriovenous Malformation (ACG 2024) - "The patient was treated with a mesalamine enema, with no response...B - X-ray of the abdomen post endovascular coil embolization of left colic artery. C - Biopsy of the sigmoid colon showing superficial mucosal detachment, mucosal hemorrhage, and hyalinization of lamina propia."

Anorexia • Atrial Fibrillation • Cardiovascular • CNS Disorders • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Hypertension • Immunology • Inflammation • Pain • Thrombosis

Chronic radiation proctitis refractory to steroid enema was successfully treated by metformin and sodium butyrate: a case report. (PubMed, J Med Case Rep) - "M-B enema and suppository may be an effective treatment for chronic RP."

Journal • Genito-urinary Cancer • Oncology • Prostate Cancer • Solid Tumor

Liver Masses Presenting as Stage IV Neuroendocrine Tumor in BRCA1 Mutation (ACG 2023) - "The patient was started on Balsalazide 750mg TID and mesalamine enemas for management of his UC. Our case represents the first instance in the literature describing the connection between BRCA1 mutations and primary pancreaticobiliary neuroendocrine tumors, proving they should remain on the differential in patients with vague presenting symptoms, specifically those with genetic mutations that might place them at higher risk for cancer incidence. Figure: Multifocal hepatic masses in the setting of BRCA1 Mutation"

Metastases • Endocrine Cancer • Gastroenterology • Gastrointestinal Disorder • Hepatology • Immunology • Neuroendocrine Tumor • Oncology • Pain • Pancreatic Cancer • Solid Tumor • BRCA • BRCA1 • CDX2

A Functional Medicine Program for Patients With Inflammatory Bowel Disease and Improvement in Fecal Calprotectin Levels (ACG 2023) - "Previous therapies included oral balsalazide, budesonide rectal foam, 6-mercaptopurine, methotrexate, adalimumab, infliximab, and vedolizumab. She achieved symptomatic improvement on tofacitinib, but serial colonoscopies showed persistent inflammation in the rectum and ascending colon...Previous therapy included mesalamine enemas...These cases show improvement in fecal calprotectin. A larger, prospective design with other measures of inflammation is needed to further investigate this effect."

Clinical • Crohn's disease • Fatigue • Gastroenterology • Gastrointestinal Disorder • Immunology • Inflammation • Inflammatory Bowel Disease • Musculoskeletal Diseases • Musculoskeletal Pain • Orthopedics • Pain • Ulcerative Colitis

Triple Action Cleaning for the Colon: Chemical Colitis from a Contact Lens Solution Containing Hydrogen Peroxide (ACG 2023) - "Patient was subsequently discharged with mesalamine enema with symptom resolution...There is no antidote or guideline on how to treat colonic exposure. Given its readily availability in various products, physicians should be aware of its complications."

Cardiovascular • Gastroenterology • Gastrointestinal Disorder • Immunology • Mood Disorders • Pain • Psychiatry • CRP

Secukinumab Induced Colitis Masquerading as IBD (ACG 2023) - "She was started on IV steroids and oral and enema mesalamine with complete resolution of abdominal pain, diarrhea, and rectal bleeding by the time of discharge 3 days later. Figure: Here we can visualize the continuous erythema and friability from the anus (Fig1.A) through the descending colon (Fig1.B). In Fig1.C, we are able to visual circumferential involvement of inflammation in the descending colon."

Celiac Disease • Crohn's disease • Dermatology • Gastroenterology • Gastrointestinal Disorder • Genetic Disorders • Hidradenitis Suppurativa • Immunology • Inflammation • Inflammatory Bowel Disease • Pain • Ulcerative Colitis • ERBB3

A Masking Effect: A Case of Initial Presentation of Ulcerative Colitis After Discontinuation of Growth Hormone (ACG 2023) - "10 out of 12 UC patients treated with epidermal growth factor enema and mesalamine were in remission after 2 weeks compared to 1/12 in the control group treated with only mesalamine...These histologic findings are consistent with inflammatory bowel disease. Figure 1: Ulcerated rectal mucosa (blue arrow) shown with colonoscopy."

Clinical • Gastroenterology • Gastrointestinal Disorder • Growth Hormone Deficiency • Immunology • Inflammatory Bowel Disease • Oncology • Pain • Ulcerative Colitis • EGF • STAT5B

Expanded table: Some drugs for inflammatory bowel disease. (PubMed, Med Lett Drugs Ther) - No abstract available

Journal • Crohn's disease • Gastroenterology • Gastrointestinal Disorder • Immunology • Inflammation • Inflammatory Bowel Disease • Ulcerative Colitis

Drugs for inflammatory bowel disease. (PubMed, Med Lett Drugs Ther) - No abstract available

Journal • Crohn's disease • Gastroenterology • Gastrointestinal Disorder • Immunology • Inflammation • Inflammatory Bowel Disease • Ulcerative Colitis

CB-01-35: A RIFAMYCIN IN SITU GEL ENEMA THAT DEMONSTRATES SUPERIOR EFFICACY COMPARED TO MESALAMINE AND DEXAMETHASONE IN A RAT OXAZOLONE MODEL OF ULCERATIVE COLITIS (DDW 2023) - "Given that Rifaximin, an ansamycin class antibiotic, has demonstrated efficacy in some UC patients, we sought to evaluate Rifamycin SV (rifamycin) as a potential therapeutic...The clinical parameters such as body weight changes, macroscopic damage score and mucosal damage area score were compared to mesalamine enema (Asacol® foam, commercially available in Europe), intraperitoneal dexamethasone and rifamycin gel placebo (vehicle)...We propose that the CB-01-35 rifamycin in situ gel enema formulation provides a longer duration of exposure of this dual-acting antibiotic / anti-inflammatory drug at the site of the damaged intestinal mucosa. As such, this provides a dual pharmacological activity leading to superior efficacy, relative to Asacol foam or dexamethasone, in this UC animal model."

Preclinical • Crohn's disease • Gastroenterology • Gastrointestinal Disorder • Immune Modulation • Immunology • Inflammation • Inflammatory Bowel Disease • Ulcerative Colitis • CXCL8 • CYP3A4 • NF-κβ

A Case of Two Concurrent Autoimmune Conditions: Autoimmune Enteropathy Hidden by Severe Ulcerative Colitis (AIBD 2022) - "Her disease was unresponsive to mesalamine enemas and suppositories. Her disease responded to oral mesalamine and azathioprine, but she developed recurrent and severe yeast infections related to azathioprine and discontinued the medication...Her disease progressed and infliximab therapy was initiated after colonoscopy showed Mayo 2 and Mayo 3 colitis...AE can occur concurrently with UC. The presence of severe UC symptoms which are difficult to treat should prompt consideration of endoscopy to rule out upper gastrointestinal inflammatory bowel disease and AE."

Clinical • Crohn's disease • Immunology • Inflammation • Inflammatory Bowel Disease • Ulcerative Colitis

The Immunoprotective Effect of the Human Immunodeficiency Virus in Delaying the Development of Inflammatory Bowel Disease (AIBD 2022) - "The patient was supposed to be on an antiretroviral therapy regimen of darunavir, cobicistat, emtricitabine, and tenofovir/alafenamide but was not taking them for over 18 months and living in squalid conditions...Imaging was negative but physical exam was concerning for esophageal candidiasis and the patient was started on a 3-week course of fluconazole...The patient was started on mesalamine enemas with remarkable improvement in symptomatology and discharged with appropriate follow-up. The presence of HIV and IBD presenting together is a rare clinical phenomenon with only a handful of reports in the literature. By reviewing the pathophysiological and clinical manifestations when these 2 diseases are present concurrently, we use our patient as a model example to describe how HIV can be protective in the development and exacerbation of IBD."

Immunology • Inflammation • Inflammatory Bowel Disease • Ulcerative Colitis • CD4

Proctitis in a Young Male Secondary to Hydrogen Peroxide Enema (ACG 2022) - "Patient had clinical improvement with mesalamine enema...Figure: Endoscopic findings showing erythematous, friable mucosa in sigmoid colon and rectum. A) normal, distal descending B) sigmoid colon C) rectum"

Constipation • Dermatology • Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Inflammatory Bowel Disease • Pain • Pruritus • Rheumatology • Ulcerative Colitis

Posterior Solitary Rectal Ulcer Syndrome (ACG 2022) - "Patient was treated conservatively with mesalamine enemas, steroids, & laxatives...Post op, he is doing well without any clinical symptoms. Figure: Posterior SRUS"

Cardiovascular • Crohn's disease • Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Inflammatory Bowel Disease • Oncology • Pain

Longstanding Proctocolitis Secondary to Chronic Inferior Mesenteric Vein (IMV) Occlusion (ACG 2022) - "Case Description/ A 43-year-old male with a past medical history of DM, HTN, renal transplant on immunosuppression, prothrombin gene mutation and DVT on apixaban initially presented with rectal pain and diarrhea of one month duration...He was started on linaclotide, mesalamine enemas, and hydrocortisone enemas...Early detection of IMVT can decrease both morbidity and mortality while effectively guiding therapy. Figure: A) Diffuse severe inflammation with mucosal friability and granularity of the descending colon B) Diffuse severe inflammation with mucosal friability and erosions in sigmoid colon C) Diffuse severe inflammation with congestion, friability, and shallow ulcerations in rectum with oozing"

Cardiovascular • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Immunology • Inflammatory Bowel Disease • Oncology • Pain • Thrombosis • Transplantation • Varicose Veins • Venous Thromboembolism

A Case of Tinnitus in a Patient With Ulcerative Colitis on Rectal Mesalamine (ACG 2022) - "The patient was started on mesalamine enemas with subsequent improvement in bowel incontinence...To control his proctosigmoiditis, budesonide foam was used with a complete clinical response...Although this patient had normal liver function, his eGFR was reduced and he was on aspirin therapy for CAD, which may have increased his risk of developing tinnitus. It is important to recognize this potential complication of mesalamine, and assess these factors prior to prescribing mesalamine, counsel patients, and maintain close follow-up of patients with risk factors, as tinnitus is often easily reversible with mesalamine discontinuation. Further studies are needed to better understand the pharmacokinetics of rectal mesalamine and its role in systemic toxicity."

Clinical • Cardiovascular • Coronary Artery Disease • Gastroenterology • Gastrointestinal Disorder • Genito-urinary Cancer • Hypertension • Immunology • Inflammatory Bowel Disease • Oncology • Otorhinolaryngology • Prostate Cancer • Renal Disease • Solid Tumor • Ulcerative Colitis

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"Those are easy! Now do a mesalamine enema and accidentally pump air in from the bottle 🙃" (@damichmich)

A Case Report of Early Eosinophilic and Ulcerative Colitis (ACG 2021) - "Her medications include bupropion, escitalopram, hydroxyzine, Depo-Provera, dicyclomine, and mesalamine rectal enema. F. Colonoscopic view showing normal colonic mucosa."

Clinical • CNS Disorders • Depression • Eosinophilia • Gastroenterology • Gastrointestinal Disorder • Genetic Disorders • Immunology • Inflammatory Bowel Disease • Migraine • Mood Disorders • Novel Coronavirus Disease • Obesity • Pain • Psychiatry • Ulcerative Colitis

Colonic Spirochetes: No Reason to Worry (ACG 2021) - "Case Description/ Case 1: An 82-year-old woman with left sided ulcerative colitis (UC) on corticosteroid enemas and mesalamine presented with generalized abdominal discomfort with nausea, vomiting, and chills without observable fevers...He was treated with omeprazole and diet modifications with improvement...While the clinical significance of IS remains unknown, we demonstrate here that symptoms do not correspond to its target treatment. We suggest providing reassurance in these patients and to avoid empiric antimicrobial therapy.Figure: Figure A: Endoscopic capture of transverse colon with biopsyFigure B: Red arrows directing at spirochetes seen in biopsy specimen after steiner stain with 400x magnification"

Anorexia • Gastroenterology • Gastrointestinal Disorder • Immunology • Inflammatory Bowel Disease • Pain • Ulcerative Colitis • MRI