Article thumbnail

Exacerbation of Bloody Diarrhea as a Side Effect of Mesalamine Treatment of Active Ulcerative Colitis

By Yuichi Shimodate, Kunihiro Takanashi, Eriko Waga, Tomoki Fujita, Shinichi Katsuki and Masafumi Nomura


Mesalamine has been used as the first-line therapy for the treatment of ulcerative colitis (UC) because of its efficacy and fewer side effects. However, earlier study showed that mesalamine occasionally causes diarrhea. We are presenting a patient with active UC in whom bloody diarrhea accompanied by abdominal pain and fever occurred and the symptoms were aggravated after administration of mesalamine. In order to clarify the reason of symptoms aggravation, drug lymphocyte stimulation test and rechallenge trial with mesalamine were performed. The results indicated the possibility that aggravation was related to allergic reaction and was dose-dependent. Furthermore, we examined colonoscopic views but there was no remarkable change in before and after rechallenge trial. Based on the above result, the patient was diagnosed with mesalamine intolerance. In order to differentiate whether the exacerbation of bloody diarrhea is due to the side effects of the mesalamine or a true relapse of UC, taking careful history before and after increasing mesalamine dosage as well as being aware of side effects of mesalamine are required. Clinicians should be aware of diarrhea as a side effect of mesalamine particularly after onset of mesalamine formulation, change in mesalamine formulation, or change in mesalamine dose

Topics: Published: April 2011
Publisher: S. Karger AG
OAI identifier:
Provided by: PubMed Central

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.

Suggested articles


  1. (1973). Adverse reactions during salicylazosulfapyridine therapy and the relation with drug metabolism and acetylator phenotype.
  2. al: Acute pancreatitis during oral 5-aminosalicylic acid therapy.
  3. (1977). al: An experiment to determine the active therapeutic moiety of sulfasalazine. Lancet
  4. (1993). al: An oral preparation of mesalamine as long-term maintenance therapy for ulcerative colitis. A randomized, placebo-controlled trial. The Mesalamine Study Group. Ann Intern Med
  5. al: Controlled trial of sulfasalazine in the treatment of ulcerative colitis.
  6. DiMarino AJ: Diarrhea as a side effect of mesalamine treatment for inflammatory bowel disease.
  7. (1996). et al: Adverse events in patients treated with 5-aminosalicylic acid: 1993–1994 pharmacovigilance report for Pentasa in France. Aliment Pharmacol Ther
  8. (1993). et al: Effect of olsalazine and mesalazine on human ileal and colonic (Na++K+)-ATPase. A possible diarrhogenic factor? Clin Investig
  9. et al: Mesalazine induced exacerbation of ulcerative colitis.
  10. (1987). Ilstrup DM: Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study.
  11. (1983). Kinetics of 5-aminosalicylic acid after jejuna instillation in man.
  12. (1993). Mesalamine capsules for treatment of active ulcerative colitis. Results of a controlled trial.
  13. (1995). Safety and efficacy of controlled-release mesalamine for maintenance of remission in ulcerative colitis. Dig Dis Sci
  14. The role of intestinal bacteria in the metabolism of salicylazosulfapyridine.
  15. (1973). Truelove SC: A controlled therapeutic trial of long-term maintenance treatment of ulcerative colitis with sulafasalazine (Salazopyrin).