The histology confirmed mild chronic active inflammation. She states she is asymptomatic with 1-2 BM per day on mesalamine 2.4 gm daily.
What would be your next step?
Increase to 4.8 gm of mesalamine
She has ongoing mild disease on endoscopy and should be optimized within her class of drug. She should have a repeat endoscopy or fecal calprotectin on 4.8gm of mesalamine prior to conceiving in order to document remission
Start a biologic
As she is asymptomatic and it is Mayo 1 disease, at this time, a biologic is not warranted. However, this can be considered if she does not achieve full remission on current therapy
Continue her current dose of mesalamine 2.4 gm as she is feeling well
Given ongoing disease activity noted endoscopically, therapy should be advanced as having active IBD can increase the risk for spontaneous abortion
Stop mesalamine altogether as she should not take it during pregnancy
Mesalamine agents are compatible with use in pregnancy.
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