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 disease distribution pattern nurses will encounter in IBD clinics.
• Retention enemas require significant patient education and coaching; nurses play a central role in teaching proper positioning, retention time, and troubleshooting adherence barriers that can make or break treatment success.
• Combination topical-plus-oral 5-ASA therapy is already a guideline-supported approach for left-sided colitis, so this study adds to the evidence base nurses can reference when counseling patients on why "two forms" of the same medication class may be recommended.
• Understanding the rationale behind combination therapy helps nursing staff set realistic expectations with patients regarding symptom timeline, enema logistics, and the importance of completing both components of the regimen rather than defaulting to oral therapy alone.

Clinical Relevance

Left-sided ulcerative colitis (E2 per the Montreal classification) sits in a therapeutic sweet spot where topical rectal therapy can meaningfully augment oral 5-aminosalicylic acid (5-ASA) treatment, since enemas can deliver higher mucosal drug concentrations to the distal colon than oral formulations alone typically achieve. For GI and endoscopy nurses, this reinforces a practice point that is sometimes underappreciated: patients with left-sided disease who are prescribed oral mesalazine enteric-coated tablets alone may be undertreated compared to those receiving combination therapy. Nurses working in IBD clinics, infusion units, or outpatient GI practices are often the first point of contact for medication counseling, and clear communication about the dual-therapy rationale can improve both understanding and adherence.

From an operational standpoint, retention enemas carry a higher burden of patient education than oral tablets. Nurses should be prepared to walk patients through practical details—emptying the bowel beforehand when appropriate, lying on the left side, retaining the enema for the recommended duration, and managing common barriers such as leakage, embarrassment, or difficulty with self-administration, particularly in older adults or patients with mobility limitations. Because treatment success in studies like this one is often measured by symptom resolution (reduction in stool frequency, rectal bleeding, urgency), nurses are well-positioned to track and document these patient-reported outcomes at follow-up visits, flagging non-responders early so the care team can reassess escalation to biologic or other advanced therapies.

This study also has implications for endoscopy scheduling and pre-procedure counseling. Patients on combination mesalazine therapy who are due for surveillance colonoscopy or flexible sigmoidoscopy may have questions about whether to continue their enema regimen around bowel prep, and nurses fielding pre-procedure calls should be equipped with consistent, evidence-informed guidance. Additionally, as retrospective cohort data accumulate supporting combination therapy for E2-type disease, nurses involved in patient education materials, clinic protocols, or IBD nurse-led clinics may want to incorporate this evidence into standardized counseling scripts or written take-home instructions to reinforce adherence outside the clinical encounter.

Bottom Line

For nurses managing patients with mild to moderate left-sided ulcerative colitis, this study underscores the clinical value of combining oral mesalazine enteric-coated tablets with mesalazine retention enemas—and highlights the nurse's essential role in educating patients on proper enema technique and adherence to maximize symptom relief and avoid undertreatment.