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 examined combination therapy—oral mesalazine enteric-coated tablets plus mesalazine retention enema—for mild to moderate E2-type (left-sided) ulcerative colitis, a common presentation seen in outpatient GI clinics and infusion/endoscopy units.
• Combination oral-rectal mesalazine regimens are increasingly used to target inflammation along the full extent of left-sided disease, and nurses play a critical role in teaching proper enema retention technique to maximize mucosal contact time and drug delivery.
• Patient adherence to retention enemas is often the limiting factor in real-world effectiveness; nurses are uniquely positioned to troubleshoot barriers such as urgency, leakage, and discomfort during enema self-administration.
• Understanding how combination therapy compares to oral monotherapy in symptom alleviation helps nurses set realistic expectations with patients and reinforces the importance of therapy-specific education during clinic visits and telephone follow-up.

Clinical Relevance

Left-sided ulcerative colitis (E2 distribution) presents unique treatment challenges because inflammation extends beyond the rectum but does not involve the entire colon, often making oral therapy alone insufficient to achieve mucosal healing in the distal colon. This study's focus on combining oral mesalazine enteric-coated tablets with retention enemas reflects a treatment strategy nurses frequently encounter when reviewing medication regimens with patients newly diagnosed or experiencing flares of mild to moderate disease. For endoscopy and GI nurses, this reinforces the value of thorough medication reconciliation and patient teaching at every touchpoint, particularly around the mechanics and rationale of rectal therapy.

From a practical nursing standpoint, retention enemas require specific patient coaching: timing of administration (often at bedtime), positioning (left lateral with hip elevation), duration of retention, and management of common side effects like urgency or spillage. Nurses working in IBD clinics, infusion centers, or telephone triage lines are often the first point of contact when patients report difficulty tolerating enema therapy or perceive it as less "convenient" than oral medication. Framing combination therapy as a way to achieve better symptom control—rather than an additional burden—can improve adherence and, by extension, clinical outcomes. This study's comparative cohort design, evaluating combination therapy against presumed monotherapy, provides evidence nurses can use when counseling patients on why their gastroenterologist may be recommending dual delivery routes rather than escalating to biologic therapy prematurely.

Additionally, retrospective cohort data like this contributes to the growing body of evidence supporting individualized, disease-distribution-specific treatment algorithms in ulcerative colitis. For GI nursing teams involved in protocol development, patient education material creation, or quality improvement initiatives, findings on combination mesalazine regimens can inform standardized teaching sheets, enema administration checklists, and follow-up scheduling to monitor symptom response and treatment adherence over time.

Bottom Line

For GI nurses, this study underscores that combining oral mesalazine enteric-coated tablets with retention enemas is a clinically relevant strategy for mild to moderate left-sided (E2) ulcerative colitis, and reinforces the nurse's essential role in patient education, adherence support, and troubleshooting enema administration to help patients achieve optimal symptom control.