Relative effectiveness of aminosalicylates in the management of acute ulcerative colitis - Mesalamine vs Sulfasalazine

Introduction: Inflammatory bowel disease (IBD) is not a single condition. It is the term for a group of disorders that cause prolonged inflammation of the digestive tract. The most common types of inflammatory bowel disease (IBD) are ulcerative colitis and Crohn's disease. Aim: The study was designed to compare the efficacy, safety, incidence of ADR'S in patients of inflammatory bowel disease with regard to the use of mesalamine, sulfasalazine and using combination of mesalamine and steroids. Materials and methods: This observational, non interventional study conducted in General Medicine Department and Gastroenterology department, Princess Esra hospital, shahali banda, within 6 months of duration. Patients selected randomly according to inclusion and exclusion criteria. A 110 patients aged 18 to 90 years, and presenting with complaints of abdomen pain, diarrhoea, bloody diarrhoea, painful defecation, altered appetite, bleeding per rectum were screened for the study after taking their informed consent. Patients were categorized into 4 groups; group I (control), group II (Mesalamine), group III (sulfasalazine), and group IV (Mesalamine + steroids) Results: Patients with age group from 18-80yrs were included in the study. The age group of 31-50age was found more prone to disease. The total percentage of male and female in 110 patients was found to be 40% (male) and 60% (female). Patients with percentage of 60% male and 40% female underwent treatment with mesalamine (Group-I), 36.6%male and 63.3%female with mesalamine + steroids (Group-II), and 30% male and 70% female with sulfasalazine (Group-III) respectively. The most common symptom was abdomen pain present in 74% patients and rectal bleeding was the next common symptom (67.21%) and other symptoms include vomiting (55.2%), loose stools (52.3%), painful defecation (44%), and reduced appetite (43.3%). The adverse effects observed during sulfasalazine treatment was abdominal pain (50%), nausea (35%), dizziness (21.6%), anorexia (16.6%), rashes (10%), gastric distress (10%), sleeping disorders (3.30%), cyanosis (3.3), hemolytic anaemia (1.60%) and mesalamine treatment was abdominal pain 21.08%, nausea 3.50%, heartburn 22%, bloated stomach 7.7% and weakness 6.64% and with mesalamine + steroids was abdomen pain 48.3%, rectal bleeding 33.3%, painful defecation 18.3%, loose tools 45%, vomiting 50% and reduced appetite 28.3%. The percentage recovery of symptoms with sulfasalazine was 60% abdomen pain, 30% rectal bleeding, 15% painful defecation, 44% loose stools, 65% vomiting, and 0% reduced appetite, with mesalamine was 40% abdomen pain, 20% rectal bleeding, 0% painful defecation, 15% loose stools, 0% vomiting, 10% reduced appetite and mesalamine + steroids was 21.6% abdomen pain, 13.3 rectal bleeding, 8.3% painful defecation, 26.6% loose stools, 15% vomiting, 18.3% reduced appetite. Conclusion: Patients of acute IBD- acute ulcerative colitis of mild type respond faster to mesalamine with or without steroids compared to sulfasalazine alone although both drugs showed good response.