Synopsis
Use conventional IBD medicines for their correct induction or maintenance role, prevent cumulative corticosteroid harm, and apply reliable laboratory, infection and reproductive safeguards.
- Mesalazine is effective for inducing and maintaining mild to moderate ulcerative colitis when formulation and route match extent; it has little general role in active Crohn disease.
- Rectal 5-ASA is an active treatment, not an optional extra, for proctitis and left-sided disease; combined oral and topical delivery can outperform either route alone.
- Systemic and locally acting corticosteroids induce remission but do not maintain it; steroid dependence, excess or refractoriness is a treatment outcome that demands a new strategy.
Key red flags
Fever, sepsis physiology, severe sore throat, spontaneous bleeding or mouth ulceration on thiopurine or methotrexate needs urgent blood count and infection assessment before another dose.
Investigation priorities
Identify contraindications and create a safety comparator before conventional immunomodulation.
Management branches
Mild to moderate ulcerative colitis is suitable for a mucosal first-line strategy.
- Map proctitis, left-sided or extensive disease and choose suppository, enema and oral delivery that physically reaches the inflamed segment.
- Explain formulation, daily routine and adherence, obtain baseline renal function and check for salicylate, sulfasalazine or excipient-specific risk.
Objective activity needs faster control than optimised first-line or maintenance therapy provides.
Key medicines
MesalazinePreparation-specific oral or rectal induction followed by a licensed maintenance regimen.
Prednisolone or budesonide formulationTime-limited induction course with formulation, taper and duration specified explicitly.