I'm sorry the basics don't seem to be doing the job any more, Kevin. FWIW, I don't find nausea to have any connection to pouchitis, at least for me. As for the cuffitis, you might try a biologic drug as a possibility. The surgical treatment is pouch advancement with mucosectomy, which should only be performed by a skilled and experienced surgeon. 

A short-term fix could be a short course of oral prednisone. Good luck!

Thanks Scott! I'm working with a local GI doc in Cincinnati who coordinates with Dr. Shen at the Cleveland Clinic, should surgical intervention be needed. I feel the need to be proactive with this and know ahead of time what my options are, as it seems like I am the one who often dictates what my treatment is.

I've never tried a biologic before and it would be interesting to see if it helped. In the past I would get cuffitis and a month of Canasa would make it go away. This time, it never went away for some reason.

I have to say, Entyvio has significantly helped my stubborn cuffitis but the side effects of a biologic are horrible. I've started calling in the Devil's brew. I'm going to explore the potential of getting a mucosectomy just because for me, the poison called biologics has not been worth it!

Interesting. My aunt takes Humira for Crohn's and doesn't really have any issues with it. I definitely need to explore the "next step" for my cuffitis treatment, because the Canasa is not working any more. I'm just trying to decide what that step is.

I have an appointment with Dr. Shen at the Cleveland Clinic at the end of December to check it out and get this thoughts. I'll keep you posted with what he decides to do.

I'm wondering if I should try to push for a mucosectomy rather than trying a biologic. I suppose there are risks associated with both. Although biologics seem to do wonders for many, in light of the cost and potential ongoing side effects, I wonder if a mucosectomy would be a safer option, in terms long term success.

FYI, I have been on Canasa permanently for a year and a half and have also tried Anucort. Although the Canasa keep my symptoms at bay for the most part, I never felt totally free of cuffitis and recently the symptoms have gotten worse (rectal and abdominal pain, and nausea/chills associated with this pain).

Hola Kevin

I got a strong and painful Cufittis immediately after my ileostomy closure and my Dr. prescribed PENTASA 1 gr for 3 months. I only have 1 month with the treatment but, after the 1st week using the suppository every night, the blood was gone and the pain has been slowly fading out. 

It is Mesalazine as well, similar to Canasa, and it might suit you better.

Also I only have 1 month using my pouch and I'm still trying to figure out which diet is the best for me, and a banana milkshake with rice milk helps to smooth the burning sensation.

Thanks Carlos! I've had my pouch for 8 years and this is the first long-term complication I've had, so I suppose I'm "lucky" in that regard. Good luck with your pouch. It will get much easier as it adapts to its new function.

That's interesting about Pentasa. Even though they're both mesalamine, it seems like I could possibly respond better to a different formulation. I read you can also take oral pentasa as well. Definitely another option to explore.

I'm still figuring what diet works best for this. All I know is that sugar is really bad for my pouch, so I avoid that as much as possible.