This study aims at evaluating the efficacy and safety of alpha-lipoic acid as adjuvant therapy to mesalamine in patients with mild to moderate ulcerative colitis due to its effect as anti-oxidant and anti-inflammatory drug which can help to improve disease.

Inclusion Criteria:

• Age ≥18 years old.
• Both male and female sex.
• Newly diagnosed patients with active mild and moderate ulcerative colitis according to American College of Gastroenterology (ACG) Clinical Guideline for diagnosing Ulcerative Colitis in Adults.26
• Patients treated with 5-aminosalisylic acid (mesalamine).

Exclusion Criteria:

• Patients with severe ulcerative colitis.
• Patients with colorectal cancer.
• Patients on rectal or systemic steroids.
• Patients on immunosuppressants or biological therapies.
• Patients with previously failed treatment with sulphasalazine.
• Patients with known allergy to study medications.
• History of complete or partial colectomy.
• Patients with significant liver disease (fibrosis, cirrhosis, NASH, NAFLD).
• Patients with other inflammatory diseases.
• Patients with thyroid diseases.
• Patients with arrhythmia, ischemic heart disease, and heart failure.
• Patients with diabetes.
• Patients on antioxidants supplement (vitamin A, C, E), selenium, co-enzyme Q.
• Patients on amlodipine, levothyroxine, low strength aspirin, warfarin, atorvastatin, insulin, oral hypoglycemic, chemotherapy (drug-drug interaction).