I've been on 5ASA meds..oral/rectal for over 20 years....still effective.
Some don't want to use the meds, are on too many initially then stop because of side effects, some aren't on rectal meds as well...basically rendering the oral meds half useful (and perceived to not be working)..etc
Yes, for some they aren't enough...but for some, even the big gun meds aren't enough and surgery is necessary.
5ASA meds are also strongly believed to protect the colon from cancer....that's a huge plus for me.
quincy