Synopsis

Source of validity: Scientific
Rating (out of 5): 4

Salicylates, particularly in the form of 5-aminosalicylic acid (5-ASA or mesalamine), are well-established first-line agents in the treatment of inflammatory bowel disorders (IBD), especially ulcerative colitis. The therapeutic use of salicylates in IBD has substantial scientific validation, supported by decades of clinical trials and guideline recommendations. 5-ASA compounds work by exerting local anti-inflammatory effects on the colonic mucosa, likely through inhibition of prostaglandin and leukotriene synthesis and modulation of immune cell activity. Numerous randomized controlled trials and meta-analyses have demonstrated their efficacy in inducing and maintaining remission in mild to moderate ulcerative colitis. Their role in Crohn’s disease is less clear, with evidence suggesting limited or no efficacy compared to placebo, but they remain a mainstay in ulcerative colitis management. The parent compound, acetylsalicylic acid (aspirin), and non-specific salicylates are not used due to gastrointestinal toxicity and lack of selectivity, but the class as a whole (especially aminosalicylates) is central in IBD care. Guidelines from organizations such as the American College of Gastroenterology and the European Crohn’s and Colitis Organisation endorse their use. In summary, there is strong scientific evidence supporting the use of specific salicylates, especially 5-ASA derivatives, in the management of inflammatory bowel disorders, particularly ulcerative colitis.

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