Palmitoylethanolamide in Ulcerative Colitis

Inclusion Criteria: * Confirmed diagnosis of ulcerative colitis (UC) by established clinical and endoscopic criteria. * Active mild-to-moderate UC patients defined by a SCCAI score ≥ 5 and \< 12 at screening not responding to 5-aminosalicylates (5-ASA) defined as persistent rectal bleeding beyond 2 weeks or failure to achieve sustained symptom relief after 40 days of appropriate 5-ASA therapy (Harbord et al., 2017), receiving a combination of 5-ASAs and corticosteroids. Exclusion Criteria: * Pregnancy or breastfeeding. * Alcohol or drug abuse. * Allergy or known hypersensitivity to palmitoylethanolamide. * Active infection (enteric or systemic). * Uncontrolled metabolic/ neurologic conditions: uncontrolled hypertension, uncontrolled diabetes, migraine disorders or other uncontrolled neurologic disease. * Other autoimmune diseases. * Severe or acute severe colitis requiring hospitalization. * UC patients requiring colectomy. * Crohn disease (CD), chronic pancreatitis, cholecystitis or other inflammatory conditions involving the gastrointestinal tract (GIT). * Patients with renal or liver disease. * Patients who have never been treated for UC. * Any patients on biologics. * Patients using NSAIDs or aspirin (due to interference with fecal calprotectin results).