What change in therapy is appropriate for a patient with ulcerative colitis reporting increased symptoms after starting esomeprazole?

The appropriate change in therapy for a patient with ulcerative colitis who reports increased symptoms after starting esomeprazole is to consider a switch from mesalamine (Apriso) to olsalazine (Dipentum).

Esomeprazole is a proton pump inhibitor used to reduce gastric acid production, which may alter the stomach environment and affect digestion, potentially exacerbating symptoms related to inflammatory bowel diseases like ulcerative colitis. In managing ulcerative colitis, aminosalicylates like mesalamine are the first line of treatment to reduce inflammation. However, some patients may not achieve adequate symptom control with mesalamine alone.

Olsalazine is an alternative aminosalicylate that works in a similar manner but may be better tolerated or more effective for some patients, offering a different therapeutic profile that could lead to improved symptom management. By switching to olsalazine, the goal is to optimize treatment and address any worsening of the patient's condition.

The other options, such as changing esomeprazole to omeprazole or simply discontinuing esomeprazole, do not provide a specific enhancement for the management of ulcerative colitis symptoms. Meanwhile, changing from one formulation of mesalamine