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 evaluated combination therapy—oral mesalazine enteric-coated tablets plus mesalazine retention enema—for patients with mild to moderate E2-type (left-sided) active ulcerative colitis, a common disease distribution seen in outpatient GI clinics and infusion/procedure units.
• Combination oral-plus-topical mesalazine therapy is a well-established first-line strategy for left-sided UC, and this study adds to the evidence base supporting its use for symptom control, though the full abstract with specific outcome data was not available at time of publication.
• Nurses play a pivotal role in patient education around retention enema technique, positioning, and dwell time, all of which directly affect topical drug delivery to the rectosigmoid mucosa and, ultimately, treatment efficacy.
• Because this is a retrospective comparative cohort design rather than a randomized controlled trial, nurses should interpret findings as hypothesis-generating and continue to individualize care based on current society guidelines and prescriber recommendations.

Clinical Relevance

Left-sided ulcerative colitis (E2 disease per the Montreal classification) presents a unique therapeutic challenge because inflammation extending to the splenic flexure is often incompletely reached by oral therapy alone. Combining an oral enteric-coated mesalazine tablet with a mesalazine retention enema is designed to achieve both systemic and topical mucosal drug concentrations, an approach frequently endorsed in UC management pathways. For GI and endoscopy nurses, this reinforces the importance of reinforcing combination regimens during pre-procedure teaching, medication reconciliation, and follow-up phone calls, since patients on dual oral/rectal therapy may have more complex regimens and lower adherence risk if instructions are unclear.

Nurses are often the primary educators for enema administration—covering optimal body positioning (left lateral decubitus), recommended retention time, timing relative to bowel movements, and strategies to manage urgency or leakage that can undermine adherence. Patients frequently report embarrassment or difficulty with rectal therapies, and nurse-led counseling can meaningfully improve both comfort and clinical outcomes. This study's focus on a real-world retrospective cohort also underscores the value of documenting patient-reported symptom relief (rectal bleeding, stool frequency, urgency) in clinical notes, as these are the outcomes most relevant to day-to-day nursing assessment and triage decisions.

From an operations standpoint, findings supporting combination therapy may influence pre-endoscopy bowel prep protocols, medication continuation instructions before colonoscopy, and discharge teaching after flexible sigmoidoscopy or colonoscopy performed to assess disease extent and activity. Nurses coordinating GI clinics or infusion units should be prepared to answer patient questions about why both an oral and a topical medication are prescribed together, and to flag nonadherence or intolerance early so it can be addressed by the ordering provider before disease flares progress.

Bottom Line

For nurses managing patients with left-sided (E2) ulcerative colitis, this study reinforces that combining oral enteric-coated mesalazine with a retention enema remains a clinically relevant strategy for symptom alleviation, and effective patient education on proper enema technique and adherence is essential to maximizing the therapeutic benefit of this dual-delivery approach.