Right-sided colitis in PSC: oral or topical mesalamine

What is known

• Topical mesalamine has limited proximal reach: suppositories to the upper rectum, foam to the sigmoid, enemas to the descending colon. ¹
• Rectal sparing and right-sided/proximal predominance are more common in PSC-IBD than in UC alone. ^2,3
• Oral mesalamine (and sulfasalazine) is approved for mild UC and controlled colitis in several reported PSC-IBD patients. ^4,5
• In one PSC-IBD cohort, a large share of patients were managed with a mesalamine product alone at some point. ²

What is unknown / caveats

• No head-to-head oral vs topical mesalamine trial for right-sided/rectal-sparing colitis in the excerpts
• Combined oral+enema data cited only for extensive disease, not isolated right-sided disease
• No excerpt reports outcomes specific to isolated right-sided colitis with rectal sparing, so comparative efficacy for this exact phenotype is unknown.

References

1. Gros B, Kaplan GG. Ulcerative Colitis in Adults: A Review. JAMA. 2023;330:951-965. PMID: 37698559.

2. [No authors listed]. Impact of ulcerative colitis on liver-related outcomes of children with primary sclerosing cholangitis. J Paediatr Child Health. 2022;58:1221-1227. PMID: 35373867.

3. Sadeghi A, Ketabi Moghadam P, Mangeli F, Salehi N, Rajabnia M. Education case: a case-based approach to overlap syndromes in autoimmune liver disease in patient with ulcerative colitis. Gastroenterol Hepatol Bed Bench. 2022. PMID: 36311961.

4. Losurdo G, Brescia IV, Lillo C, Mezzapesa M, Barone M, Principi M, Ierardi E, Di Leo A, Rendina M. Liver involvement in inflammatory bowel disease: What should the clinician know?. World J Hepatol. 2021. PMID: 34904028.

5. Oshitani N, Jinno Y, Sawa Y, Nakamura S, Matsumoto T, Nishiguchi S, Seki S, Higuchi K, Arakawa T. Does colitis associated with primary sclerosing cholangitis represent an actual subset of ulcerative colitis?. Hepatogastroenterology. 2003. PMID: 14696415.

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Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct.