Are biologics overkill for 4cm of active inflammation?

Hi everyone, so I’m on the edge about biologics right now and looking for some advice regarding this important decision..

My situation is the following:

- Diagnosed pancolitis about 4 years ago.

- Started with Pentasa before a 15-times-a-day to bathroom flare that required Prednisone.

- That lead to me starting on Azathioprine (Imuran) 3 years ago.

- Mesalazine was added in 1.5 years ago due to calprotectin rising.

- Started bleeding with every BM for just over a year now. During this time, I’ve been on max oral dose of Mesalazine, 200mg Imuran and rectal meds. Started with retention enemas, then after calprotectin dropped and symptoms improved a bit, moved on to nightly mesalazine suppositories.

- Bleeding came back to being daily again and also experiencing pain/burning after each BM as if I could feel the wound, can feel my pulse down there. Been on nightly budesonide rectal foam for 5 months in the morning in addition to the nightly suppository.

- Latest Calprotectin a few weeks ago was 2800

- Im currently going 1-3 times a day, some days I might not go at all (Ive eliminated grains lately which may be why), today is only one BM for example. I sometimes experience urgency when I'm out and I know I will be heading home after (opening the front door brings on the worse part of the urgency).

- I don't have any symptoms outside of losing blood, mucus and experiencing the burning type pain for about 2 hours after. My previous bad times in the past did give me lots of trapped gas, implosions and an overall ill-feeling but it's not present at the moment.

My question is if adding in a biologic is overkill when the inflammation is limited to the last few CM's even though my quality if life is affected by this, mostly during a couple hours of the day, I feel like I'm bringing out the big guns and all the risks that come with it and fear it will create more damage to other parts of my body that I already have, not to mention put me at risks of serious infections.

My appointment with the GI is next week to discuss this treatment and I think I'm going to do a 7-day juice only diet until then, partly because I feel I need to exhaust some options or at least try harder and partly because I watched this recently on YouTube about how 2 people with IBD saw great results juicing (its called Jason Vale – Super Juice Me! Documentary).

What are your thoughts on moving to these meds with my current inflammation? I'm concerned the rectal meds haven't helped at all really, even the budesonide..

Thanks.
1Wish

Thanks TroubledTurds. I will read up on that. As I feel Im against time due to seeing the doc in 7 days Ive opted for a more extreme approach via a 7-day juice diet for now. Wouldn’t help to lose a little weight either.

That IBD-AID doesn’t look too restrictive so will likely continue that after and maintain some juices.

Hey Poopydoop, thanks!

What helped you get out of that flare in the end? You are currently on meds?

Glad that it started working! 3 years is great!

Ive just started the 7-day juice journey today. I generally feel very good, its just the blood and some pain lingering afterwards thats the issue, maybe Ill see an improvement over the next few days.

Im hoping this new GI will be understanding when I see him on Thursday.

Ive noticed that also from going gluten free the last 7 days, ny bms are down but likely missing fibre.