Ulcerative Colitis Clinical Case Review

Eugenia Uche-Anya, MD, MPH, gastroenterology fellow at Massachusetts General Hospital, reveals the selected treatment:

"Given the increased efficacy of topical mesalamine in inducing remission and lower likelihood of adverse effects, mesalamine enemas are usually the first line therapeutic agents for mild ulcerative colitis with limited distal involvement. However, the patient noted that he was unwilling to administer rectal medications and would very much prefer an oral medication instead. Through shared clinical decision making it was decided to proceed with oral mesalamine.

He was counseled on the adverse effects with mesalamine use. More common adverse effects include headache, nausea, abdominal pain, diarrhea. More uncommonly patients on mesalamine may have a rash, pancreatitis, liver test abnormalities or paradoxical worsening of colitis and rarely pancytopenia, interstitial nephritis and pericarditis.

Our patient was started on oral mesalamine two grams daily with routine monitoring of his complete blood count, renal function and liver tests. He noted clinical improvement in his symptoms at his follow up visit in eight weeks."