What are the treatments to reduce inflammation associated with ulcerative colitis (UC)?

From the Guidelines

To decrease inflammation related to colitis, the most effective approach is to use mesalazine 2–4 g daily or balsalazide 6.75 g daily as first-line therapy for mild to moderately active disease. This recommendation is based on the guidelines for the management of inflammatory bowel disease in adults, which suggest that these medications are effective in reducing inflammation 1.

Medical Treatments

• Mesalazine 2–4 g daily or balsalazide 6.75 g daily are effective first-line therapy for mild to moderately active disease 1.
• Prednisolone 40 mg daily can be used for patients who require a prompt response or those with mild to moderately active disease who have not responded to mesalazine 1.
• Azathioprine 1.5–2.5 mg/kg/day or mercaptopurine 0.75–1.5 mg/kg/day can be used for long-term treatment of chronic active steroid-dependent disease 1.

Lifestyle Modifications

• Adopting an anti-inflammatory diet, staying well-hydrated, and managing stress through meditation or yoga can also help reduce inflammation.
• Regular moderate exercise, such as walking 30 minutes daily, can help reduce inflammation.
• Probiotics containing Lactobacillus and Bifidobacterium strains may help maintain gut flora balance [no direct evidence provided, but general knowledge]. It is essential to note that the management of colitis should be individualized, and patients should work closely with their healthcare provider to determine the best course of treatment 1.

From the FDA Drug Label

The mechanism of action of mesalamine is not fully understood, but it appears to have a topical anti-inflammatory effect on the colonic epithelial cells Mucosal production of arachidonic acid metabolites, both through the cyclooxygenase and lipoxygenase pathways, is increased in patients with ulcerative colitis, and it is possible that mesalamine diminishes inflammation by blocking cyclooxygenase and inhibiting prostaglandin production in the colon. To decrease inflammation related to colitis, mesalamine may be used, as it has a topical anti-inflammatory effect on the colonic epithelial cells and may diminish inflammation by blocking cyclooxygenase and inhibiting prostaglandin production in the colon 2.

• Mesalamine is a potential treatment option for decreasing inflammation related to colitis.
• The exact mechanism of action is not fully understood, but it is thought to have a local anti-inflammatory effect on the colon. Note that sulfasalazine is also indicated for the treatment of mild to moderate ulcerative colitis, and as adjunctive therapy in severe ulcerative colitis, but the exact mechanism of action is not described in the provided text 3.

From the Research

Decreasing Inflammation Related to Colitis

To decrease inflammation related to colitis, several treatment options are available.

• Aminosalicylates, such as 5-ASA, sulfasalazine, and mesalazine, play a central role in the treatment of ulcerative colitis (UC) 4, 5, 6.
• Topical therapy with 5-ASA suppositories or enemas is effective for treating mild to moderate active disease, particularly for distal ulcerative colitis 4, 7.
• Oral 5-ASA is also safe and effective for maintenance treatment and is generally well tolerated 4, 5.
• High-dose 5-ASA therapy may be a valuable option for patients with moderately active disease 5, 6.
• Corticosteroids are the mainstay of treatment for hospitalized patients with acute severe ulcerative colitis (ASUC), but the addition of mesalamine to corticosteroids did not show significant benefits in a randomized controlled trial 8.

Treatment Options

The following treatment options are available for decreasing inflammation related to colitis:

• Aminosalicylates: 5-ASA, sulfasalazine, and mesalazine 4, 5, 6
• Topical therapy: 5-ASA suppositories or enemas 4, 7
• Oral 5-ASA: for maintenance treatment 4, 5
• Corticosteroids: for hospitalized patients with ASUC 8
• Combination therapy: oral and rectal mesalazine for patients with both distal and extensive colitis 5

Dosage and Administration

The dosage and administration of these treatment options vary:

• 5-ASA: 4 g/d for acute treatment of mild to moderate flares, 2 x 500 mg or 1 x 1 g suppositories for ulcerative proctitis, and 1 to 4 g enemas for proctosigmoiditis 4
• Mesalazine: up to 4-4.8 g/day for induction of remission, particularly in patients with more moderate disease activity 5
• Corticosteroids: dosage and administration vary depending on the specific treatment protocol 8