Topical Therapy

Topical mesalazine is an effective alternative to steroids enemas during the acute-phases of left-sided colitis [17-24]. In two recent meta-analyses, rectal 5-ASA was superior to rectal steroids in inducing clinical, endoscopic and histologic improvement [25, 26].

Mesalazine enemas were as effective as oral sul-fasalazine but with fewer adverse effects in left-sided mild/moderate UC [27]. The drug induced remission in a duration-dependent but not in a dose-dependent way [26].

In a recent comparison of the use of these old drugs according to international guidelines in IBD patients, it was concluded that (1) 64% of patients received suboptimal dosages of oral 5-ASA, despite the evidence that their efficacy is dose-related; (2) topical aminosalicylates were not used in 75% of patients with distal colitis, despite the evidence that combined oral and topical therapy is more effective than systemic therapy alone [28, 29].

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