Mildly to Moderately Active Left-Sided Ulcerative Colitis: When Rectal Enema Therapy Alone Did Not Achieve Remission
Clinical Scenario
This protocol addresses patients with mildly to moderately active left-sided ulcerative colitis whose disease has not responded adequately to rectal therapy used alone. It defines the structured next step once remission goals have not been met within the expected reassessment window.
Previous Treatment Line — Remission Goals Not Reached
The prior regimen was rectal 5-ASA enema given as monotherapy for induction of remission.
Reassessment at 8 weeks found that the following targets were not achieved:
absence of rectal bleeding, no bowel urgency, normalised stool frequency,
and a Mayo endoscopic score of 0 or 1.
Failure to reach these endpoints triggers escalation to the present protocol.
Next-Line Approach — Partial Overview
The evidence-based next step combines rectal and oral 5-ASA therapy together,
rather than continuing the rectal route alone — targeting the same remission goals
through a dual-route approach. Full dosing thresholds, agent selection, and decision points
are contained in the complete structured protocol.
Complete regimen and clinical algorithm available below →
Remission Targets
- Absence of rectal bleeding
- No bowel urgency
- Normalised stool frequency
- Mayo endoscopic score of 0 or 1
References
- In patients with mildly to moderately active left-sided UC, we suggest rectal 5-ASA enemas at a dose of at least 1 g/daily combined with oral 5-ASA at a dose of at least 2.0 g/daily compared with oral 5-ASA therapy alone for induction of remission.
- In clinical trials, the definition of clinical remission has been a MES of 0 or 1, stool frequency of ≤1, and absence of rectal bleeding.
DOI: 10.14309/ajg.0000000000003463
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