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 combination therapy—oral mesalazine enteric-coated tablets plus mesalazine retention enema—for patients with E2-type (left-sided) mild to moderate active ulcerative colitis, a common presentation seen in GI clinics and endoscopy units.
• Combination topical and oral 5-ASA therapy is already a guideline-supported approach for left-sided UC, and this study adds real-world comparative data that nurses can use when reinforcing the rationale for dual-route therapy during patient education.
• Successful outcomes with retention enemas are highly dependent on correct administration technique, retention time, and patient positioning—areas where nursing instruction has a direct, measurable impact on treatment efficacy.
• Nurses coordinating care for UC patients should anticipate questions about why both an oral and rectal formulation are needed, and be prepared to explain the complementary mechanisms (systemic vs. topical mucosal delivery) in accessible terms.

Clinical Relevance

Ulcerative colitis management continues to evolve, but mesalazine (5-aminosalicylic acid) remains first-line therapy for mild to moderate disease, particularly in left-sided (E2) distribution where the rectum and distal colon are most involved. This study's retrospective comparative design reinforces a treatment pattern many GI nurses already encounter clinically: patients prescribed enteric-coated oral tablets alone versus those receiving the oral formulation combined with a retention enema. Understanding the comparative symptom alleviation data—once published—will help nursing staff set realistic expectations with patients regarding time to symptom improvement, stool frequency normalization, and rectal bleeding resolution.

From a practical standpoint, the nursing role in supporting combination therapy cannot be overstated. Retention enemas require specific patient education: positioning (left lateral decubitus with knees drawn up), timing (often before bed to maximize retention), and realistic counseling about initial discomfort or urgency. Nurses in GI clinics, infusion centers, and even endoscopy units performing surveillance colonoscopies for UC patients are well positioned to reinforce adherence counseling, since non-adherence to topical therapy is a well-documented barrier to achieving mucosal healing in distal colitis. This study's focus on a "real-world" retrospective cohort—rather than a tightly controlled RCT—also makes its findings more directly applicable to the heterogeneous patient populations nurses manage day to day, including those with variable adherence patterns and comorbidities.

For unit operations, this research underscores the importance of structured patient teaching protocols and possibly standardized education materials for combination 5-ASA regimens. Nurses conducting pre-treatment counseling or follow-up telephone triage can use findings from comparative studies like this to answer common patient concerns about why oral therapy alone may be insufficient for left-sided disease. This also supports a broader professional development point: staying current on evolving evidence for topical versus combination 5-ASA therapy equips nurses to engage more confidently in multidisciplinary rounds and patient advocacy discussions with gastroenterologists.

Bottom Line

For GI nurses, this study reinforces that combination oral mesalazine plus retention enema therapy—rather than oral therapy alone—is an important strategy for mild to moderate left-sided (E2) ulcerative colitis, and that nursing-led patient education on proper enema technique and adherence is a critical, modifiable factor in achieving optimal symptom control.