Therapy

Why?

• Rectal aminosalicylates lead to more remission than low-dose rectal steroids or rectal budesonide, but are not clearly better than high-dose rectal steroids ^a
• Combining rectal and oral aminosalicylates stops rectal bleeding in more patients and sooner (on average by 13 days) than either alone ^a

Ulcerative colitis: combining oral and rectal mesalamine stops rectal bleeding better than either alone

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
distal ulcerative colitis a	daily oral mesalamine and twice weekly rectal mesalamine	oral or rectal mesalamine	cessation of rectal bleeding at 6 weeks	60%	40% (1% to 96%)	4 (2 to 88)

Ulcerative colitis: rectal 5-ASA is more effective than low-dose rectal steroids at inducing remission

Patient	Treatment	Comparison	Outcome	CER	OR (95% CI)	NNT (95% CI)
distal ulcerative colitis a	low-dose rectal corticosteroids	rectal 5-ASA	symptomatic remission at 2-7 weeks	9%	2.42 (1.72 to 3.41)	-10 (-18 to -6)
	rectal 5-ASA	budesonide	symptomatic remission at 4 weeks	9%	0.41 (0.18 to 0.94)	20 (14 to 200)