From the Guidelines
The management of mild colitis should start with standard dose mesalamine (2–3 grams/d) or diazo-bonded 5-ASA, as recommended by the AGA guidelines 1. The approach to managing mild colitis involves a step-up strategy, with 5-aminosalicylates (5-ASAs) being the first-line therapy.
- The AGA recommends using either standard dose mesalamine (2–3 grams/d) or diazo-bonded 5-ASA, rather than low dose mesalamine, sulfasalazine, or no treatment 1.
- For patients with extensive mild-moderate ulcerative colitis, adding rectal mesalamine to oral 5-ASA is suggested 1.
- In cases where there is a suboptimal response to standard-dose mesalamine or diazo-bonded 5-ASA, or with moderate disease activity, using high-dose mesalamine (>3gm/d) with rectal mesalamine is recommended for induction of remission 1.
- For patients with left-sided mild-moderate ulcerative proctosigmoiditis or proctitis, mesalamine enemas (or suppositories) are suggested rather than oral mesalamine 1.
- The use of probiotics, curcumin, or fecal microbiota transplantation is not recommended due to a knowledge gap or lack of evidence 1. The goal of treatment is to induce and maintain remission, reduce symptoms, and improve quality of life.
- Regular monitoring of symptoms, including stool frequency, blood in stool, and abdominal pain, is essential to assess treatment response.
- Patients should be advised that consistent medication adherence is crucial for preventing flares, even when symptoms improve.
- Dietary modifications, such as avoiding trigger foods and maintaining adequate hydration, may also help manage symptoms.
From the Research
Management Approach for Mild Colitis
The management of mild colitis typically involves the use of aminosalicylates, such as 5-aminosalicylic acid (5-ASA), as the first line of treatment 2, 3, 4.
- Topical 5-ASA is often used for distal disease, while oral aminosalicylates are effective for both distal and extensive mild-to-moderate disease 2.
- The choice of treatment depends on the severity and extent of the inflammation, as well as the patient's response to therapy 2, 5.
- For patients with mild ulcerative colitis, oral or topical 5-ASA preparations are often sufficient, with topical steroids such as budesonide used as an alternative 3.
- In some cases, immunosuppressive therapy with azathioprine or 6-mercaptopurine may be necessary for patients with severe or chronic disease 2, 4, 6.
Treatment Options
The following treatment options are available for mild colitis:
- Aminosalicylates (5-ASA) 2, 3, 4
- Topical steroids (e.g. budesonide) 3
- Oral corticosteroids 2, 4
- Immunomodulators (e.g. azathioprine, 6-mercaptopurine) 2, 4, 6
- Biologic agents (e.g. infliximab, vedolizumab) 5
Considerations for Treatment
When managing mild colitis, it is essential to consider the following: