Synopsis

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

Sulfur compounds, particularly in the form of sulfasalazine, have a well-established scientific basis for use in treating Inflammatory Bowel Disorders (IBD), such as ulcerative colitis and, to a lesser extent, Crohn’s disease. Sulfasalazine is a prodrug composed of sulfapyridine and 5-aminosalicylic acid (5-ASA), joined by a diazo bond. When administered orally, sulfasalazine is broken down by colonic bacteria to release 5-ASA, which exerts anti-inflammatory effects in the gut mucosa by inhibiting prostaglandin and leukotriene synthesis, scavenging free radicals, and modulating the immune response. Numerous randomized controlled trials and systematic reviews have demonstrated the efficacy of sulfasalazine and related 5-ASA drugs in inducing and maintaining remission in mild to moderate ulcerative colitis. Sulfasalazine has been used in clinical practice since the 1940s, and its effectiveness is recognized in major clinical guidelines. While elemental sulfur itself is not used for IBD, the medicinal use of sulfur-containing compounds is firmly rooted in modern pharmacology rather than tradition. Other sulfur compounds, such as methionine or cysteine, do not have evidence for IBD treatment. The rating of 4 reflects robust clinical trial support for sulfasalazine (and its sulfur component), but acknowledges that newer non-sulfur 5-ASA agents may be preferred due to fewer side effects.

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