The place of various topical forms of mesalazine in the treatment of ulcerative colitis

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Abstract

Ulcerative colitis (UC) is a chronic non-specific inflammatory bowel disease that involves the rectum and spreads proximally. According to the extent of the process, proctitis, left-sided and total UC are distinguished, while the distal forms of the disease account for more than half of all detected cases. Mesalazines, the main component of which is 5-aminosalicylic acid (5-ASA), are the drugs of choice for mild-to-moderate forms of the disease. For the implementation of the therapeutic effect of 5-ASA, direct contact with the mucous membrane of the colon or rectum is required, and without appropriate protection, 5-ASA is completely absorbed in the upper gastrointestinal tract. Therefore, when choosing therapy for patients with distal forms of UC, local forms of preparations, such as rectal suppositories, suspension or foam with mesalazine, are optimal. Rectal suppositories are effective for mild-to-moderate proctitis, they are proven to be superior in effectiveness to local forms of glucocorticosteroids. In a more widespread inflammatory process, a rectal suspension with 5-ASA is used, which can reach the right flexure of the colon and have a therapeutic effect. In case of violation of the reservoir capacity of the rectum, for example, with severe inflammation, rectal foam with mesalazine will be an alternative. Due to the fact that 5-ASA preparations are effective and safe, therapy for distal forms of UC begins with their administration; in case of inefficiency or intolerance, it is possible to replace them with topical glucocorticosteroids. With a more widespread inflammatory process, combined therapy with systemic and local aminosalicylates is recommended, which contributes to a faster achievement of remission and its maintenance for a longer period.

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About the authors

S. S. Belous

Ryzhykh National Medical Research Center for Coloproctology

Author for correspondence.
Email: Sofiabelous@yandex.ru
ORCID iD: 0000-0003-1180-0524

Cand. Sci. (Med.), Head of Day-Stay Hospital

Russian Federation, Moscow

B. A. Nanaeva

Ryzhykh National Medical Research Center for Coloproctology

Email: Sofiabelous@yandex.ru
ORCID iD: 0000-0003-1697-4670
Russian Federation, Moscow

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