Ananthakrishnan AN, Xavier RJ, Podolsky DK. Inflammatory bowel disease: a clinician's guide, 1st edn. Chichester: Wiley Blackwell; 2017

Crohn's and Colitis UK. Ulcerative colitis: your guide. 2019. (accessed 9 July 2020)

Cope G. Innovations in IBD treatment. Gastrointest Nurs. 2015; 13:(3)6-8

Cutler RL, Fernandez-Llimos F, Frommer M, Benrimoj C, Garcia-Cardenas V. Economic impact of medication non-adherence by disease groups: a systematic review. BMJ Open. 2018; 8:(1)

Dignass A, Lindsay JO, Sturm A Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 2: current management. J Crohns Colitis. 2012; 6:(10)991-1030

Fissell RB, Karaboyas A, Bieber BA Phosphate binder pill burden, patient-reported non-adherence, and mineral bone disorder markers: findings from the DOPPS. Hemodial Int. 2016; 20:(1)38-49

Ford AC, Achkar JP, Khan SV Efficacy of 5-ASA in UC: a meta-analysis. Am J Gastroenterol. 2011; 106:601-616

Ford AC, Khan KJ, Sanborn WJ, Hanauer SB, Moayyedi P. Efficacy of topical 5-aminosallycillates in preventing relapse of quiescent UC: a meta-analysis. Clin Gastroenterol Hepatol. 2012; 10:513-519

Gisbert JP, Chaparro M. Acute severe ulcerative colitis: state of the art treatment. Best Pract Res Clin Gastroenterol. 2018; 32–33:59-69

Harbord M, Eliakim R, Bettenworth D Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 2: current management. J Crohns Colitis. 2017; 11:(7)769-784

Hodgkins P, Swinburn P, Solomon D, Yen L, Dewilde S, Lloyd A. Patient preferences for first-line oral treatment for mild-to-moderate ulcerative colitis: a discrete-choice experiment. Patient. 2012; 5:(1)33-44

Janmohamed N, Steinhart AH. Measuring severity of anxiety and depression in patients with inflammatory bowel disease: low concordance between patients and male gastroenterologists. Inflamm Bowel Dis. 2017; 23:(7)1168-1173

Kamp KJ, Brittain K. Factors that influence treatment and non-treatment decision making among individuals with inflammatory bowel disease: an integrative review. Patient. 2018; 11:(3)271-284

Kato S, Ishibashi A, Kani K, Yakabi K. Optimized management of ulcerative proctitis: when and how to use mesalazine suppository. Digestion. 2018; 97:(1)59-63

Kemp K, Dibley L, Chauhan U Second N-ECCO consensus statements on the European nursing roles in caring for patients with Crohn's disease or ulcerative colitis. J Crohns Colitis. 2018; 12:(7)760-776

Lamb CA, Kennedy NA, Raine T British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut. 2019; 68:s1-s106

Magro F, Gionchetti P, Eliakim R Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 1: definitions, diagnosis, extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disorders. J Crohns Colitis. 2017; 11:(6)649-670

Mongkhon P, Ashcroft DM, Scholfield CN, Kongkaew C. Hospital admissions associated with medication non-adherence: a systematic review of prospective observational studies. BMJ Qual Saf. 2018; 27:(11)902-914

Mowat C, Cole A, Windsor A Guidelines for the management of inflammatory bowel disease in adults. Gut. 2011; 60:(5)571-607

National Institute for Health and Care Excellence. Faecal incontinence in adults. Quality standard QS54. 2014. (accessed 7 July 2020)

Ulcerative colitis: management.London: National Institute for Health and Care Excellence; 2019

National Institute for Health and Care Excellence. Ulcerative colitis overview. 2020. (accessed 7 July 2020)

Párraga-Martínez I, Rabanales-Sotos J, Lago-Deibe F Effectiveness of a combined strategy to improve therapeutic compliance and degree of control among patients with hypercholesterolaemia: a randomised clinical trial. BMC Cardiovasc Disord. 2015; 15:(1)

Plevinsky J, Greenley R, Fishman L. Self-management in patients with inflammatory bowel disease: strategies, outcomes, and integration into clinical care. Clin Exp Gastroenterol. 2016; 9:259-267

Seibold F, Fournier N, Beglinger C Topical therapy is underused in patients with ulcerative colitis. J Crohns Colitis. 2014; 8:(1)56-63

Siegel CA, Lofland JH, Naim A Novel statistical approach to determine inflammatory bowel disease: patients' perspectives on shared decision making. Patient. 2016; 9:(1)79-89

Stange EF, Travis SP, Vermeire S European evidence-based consensus on the diagnosis and management of ulcerative colitis: definitions and diagnosis. J Crohns Colitis. 2008; 2:(1)1-23

Testa A, Castiglione F, Nardone OM, Colombo GL. Adherence in ulcerative colitis: an overview. Patient Prefer Adherence. 2017; 11:297-303

Tortora GJ, Derrickson B. Principles of anatomy and physiology, 14th edn. Hoboken (NJ): Wiley; 2014

Truelove SC, Witts LJ. Cortisone in ulcerative colitis; final report on a therapeutic trial. BMJ. 1955; 2:(4947)1041-1048

Vangeli E, Bakhshi S, Baker A A systematic review of factors associated with non-adherence to treatment for immune-mediated inflammatory diseases. Adv Ther. 2015; 32:(11)983-1028

Vavricka SR, Bentele N, Scharl M Systematic assessment of factors influencing preferences of Crohn's disease patients in selecting an anti-tumor necrosis factor agent (CHOOSE TNF TRIAL). Inflamm Bowel Dis. 2012; 18:(8)1523-1530

Watson R. Anatomy and physiology for nurses, 13th edn. London: Baillière Tindall Elsevier; 2011

Waugh A, Grant A. Anatomy and physiology in health and illness, 10th edn. London: Churchill Livingstone Elsevier; 2006

Inflammatory bowel disease nursing, 2nd edn. In: Whayman K, Duncan J, O'Connor M (eds). London: Quay Books; 2011

Review of normal gastrointestinal tract, ulcerative colitis, proctitis and rectal medication adherence

23 July 2020
13 min read
Volume 29 · Issue 14


The gastrointestinal (GI) tract has a number of functions—ingestion, digestion, absorption and elimination. When the GI tract is working normally, it is efficient. However, this can change when disease, such as inflammatory bowel disease (IBD) occurs. IBD is a long-term relapsing and remitting autoimmune disease; it incorporates ulcerative colitis (UC). In UC, part or all the mucosa lining the rectum and colon becomes inflamed and ulcerated. UC that affects the rectum only is called proctitis. Effective treatment is essential. It is better to target the rectal mucosa directly in proctitis, using topical rectal medications in enemas or suppositories, as these have fewer side-effects and resolve symptoms more quickly than systemic drugs. However, patients may not feel clear about aspects of their IBD care and can find it difficult to initiate and comply with treatment and maintenance regimens. Nurses need to educate and support them to achieve optimal therapeutic outcomes in both the immediate and long terms.

The gastrointestinal tract begins at the mouth and ends at the anus. In health, the time taken from ingestion to elimination in the Western world is about 1–3 days (Tortora and Derrickson, 2014). This transit time is longer for people with constipation and shorter for people with diarrhoea.

The mouth contains teeth, required for chewing food, and saliva, which keeps the mouth moisturised and supple as well as being responsible for the first part of the chemical breakdown of food. Once food has been ingested and chewed, it passes to the stomach where chemical breakdown continues with the gastric juices. The stomach is acidic; this helps to prevent infection caused by any ingested bacteria. The stomach's strong muscle walls mechanically churn the food to help to break it down into the various components that are required by the body, such as amino acids, which are broken-down proteins. Food stays in the stomach for several hours while breakdown occurs. Little is absorbed directly from the stomach (Watson, 2011).

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content