Mesalazine enteric-coated tablets combined with retention enema for symptom alleviation in mild to moderate E2-type active ulcerative colitis: A retrospective comparative cohort study.

Key Takeaways for GI Nurses

• This retrospective cohort study examines a combination approach—oral mesalazine enteric-coated tablets plus mesalazine retention enema—for patients with E2-type (left-sided) mild to moderate active ulcerative colitis, reinforcing the clinical rationale for dual oral/topical 5-ASA therapy in this UC subtype.
• GI nurses play a critical role in patient education around retention enema technique, since proper administration (positioning, retention time, timing relative to bowel movements) directly affects whether patients achieve adequate mucosal drug delivery and symptom relief.
• Combination therapy often means more complex medication regimens; nurses are well positioned to reinforce adherence counseling, address barriers to enema use (embarrassment, discomfort, lifestyle disruption), and monitor for symptom trends across visits.
• As a retrospective comparative cohort design, findings should be interpreted as hypothesis-generating; nurses can use this study to inform patient conversations about topical therapy options while awaiting more robust prospective data.

Clinical Relevance

Left-sided ulcerative colitis (E2 distribution) presents unique treatment challenges because disease activity extends beyond the rectum but does not reach the splenic flexure, making topical therapy alone often insufficient while oral therapy alone may under-treat distal inflammation. This study's focus on combining oral mesalazine with retention enemas reflects a treatment strategy already endorsed in several UC guidelines, and its retrospective comparative design adds real-world clinical experience to the evidence base. For nursing teams, this reinforces the importance of understanding disease distribution when counseling patients—recognizing that a "one-size-fits-all" oral-only regimen may not achieve adequate symptom control for left-sided disease.

From a practical standpoint, nurses are often the primary point of contact for teaching patients how to self-administer retention enemas correctly, including tips such as evacuating the bowel beforehand, lying in the left lateral position, and retaining the enema for as long as tolerable to maximize mucosal contact time. Poor technique is a common reason for suboptimal topical therapy outcomes, and nurse-led teaching sessions—whether in the outpatient GI clinic, infusion suite, or via telehealth follow-up—can meaningfully improve adherence and, by extension, clinical response. Addressing patient concerns about the enema's inconvenience or discomfort with empathy and practical problem-solving (e.g., bedtime administration, use of positioning aids) is an important nursing contribution that complements pharmacologic management.

This study also serves as a reminder for GI nursing staff to standardize symptom-tracking practices when combination therapy is initiated—monitoring stool frequency, rectal bleeding, urgency, and abdominal pain at each visit or via structured patient-reported outcome tools. Consistent, nurse-driven symptom documentation supports the multidisciplinary team in assessing treatment response and can help identify patients who may need step-up therapy or gastroenterologist reassessment sooner rather than later. Additionally, understanding the retrospective, comparative nature of this evidence encourages nurses to advocate for enrollment in future prospective trials when appropriate, strengthening the evidence base for topical/oral combination regimens in E2-type UC.

Bottom Line

For GI nurses, this study underscores that effective management of mild to moderate left-sided ulcerative colitis often requires combining oral mesalazine with retention enemas rather than relying on oral therapy alone—making patient education on proper enema techn