5-Aminosalicylic acid enema in the treatment of distal ulcerative colitis, proctosigmoiditis, and proctitis

Sutherland, Lloyd R.; Martin, Francois; Greer, Scott; Robinson, Malcolm; Greenberger, Norton; Saibil, Fred; Martin, Thomas; Sparr, Joseph; Prokipchuk, Ed; Borgen, Lowell

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Volume 92, Issue 6 , Pages 1894-1898, June 1987

5-Aminosalicylic acid enema in the treatment of distal ulcerative colitis, proctosigmoiditis, and proctitis☆

Lloyd R. Sutherland
- Address requests for reprints to: Dr. L. R. Sutherland, 3330 Hospital Drive NW, Room 1414, Calgary, Alberta, Canada T2N 4N1.
- Department of Gastroenterology at the University of Calgary, Calgary, Canada
- Department of Gastroenterology at the University of Montreal, Montreal, Canada
- Department of Gastroenterology at the Scripps Medical Clinic, La Jolla, California, USA
- Department of Gastroenterology at the Oklahoma City Clinic, Oklahoma City, Oklahoma, USA
- Department of Gastroenterology at the Kansas University, Lawrence, Kansas, USA
- Department of Gastroenterology at the University of Toronto, Toronto, Canada
- Department of Gastroenterology at the St. Paul Gastroenterology, St. Paul, Minnesota, USA
- Department of Gastroenterology at the Atlantic Gastroenterology, New Jersey, USA
- Department of Gastroenterology at the Clinical Research Department, Reid-Rowell, Inc., Baudette, Minnesota, USA
Francois Martin
- Department of Gastroenterology at the University of Calgary, Calgary, Canada
- Department of Gastroenterology at the University of Montreal, Montreal, Canada
- Department of Gastroenterology at the Scripps Medical Clinic, La Jolla, California, USA
- Department of Gastroenterology at the Oklahoma City Clinic, Oklahoma City, Oklahoma, USA
- Department of Gastroenterology at the Kansas University, Lawrence, Kansas, USA
- Department of Gastroenterology at the University of Toronto, Toronto, Canada
- Department of Gastroenterology at the St. Paul Gastroenterology, St. Paul, Minnesota, USA
- Department of Gastroenterology at the Atlantic Gastroenterology, New Jersey, USA
- Department of Gastroenterology at the Clinical Research Department, Reid-Rowell, Inc., Baudette, Minnesota, USA
Scott Greer
- Department of Gastroenterology at the University of Calgary, Calgary, Canada
- Department of Gastroenterology at the University of Montreal, Montreal, Canada
- Department of Gastroenterology at the Scripps Medical Clinic, La Jolla, California, USA
- Department of Gastroenterology at the Oklahoma City Clinic, Oklahoma City, Oklahoma, USA
- Department of Gastroenterology at the Kansas University, Lawrence, Kansas, USA
- Department of Gastroenterology at the University of Toronto, Toronto, Canada
- Department of Gastroenterology at the St. Paul Gastroenterology, St. Paul, Minnesota, USA
- Department of Gastroenterology at the Atlantic Gastroenterology, New Jersey, USA
- Department of Gastroenterology at the Clinical Research Department, Reid-Rowell, Inc., Baudette, Minnesota, USA
Malcolm Robinson
- Department of Gastroenterology at the University of Calgary, Calgary, Canada
- Department of Gastroenterology at the University of Montreal, Montreal, Canada
- Department of Gastroenterology at the Scripps Medical Clinic, La Jolla, California, USA
- Department of Gastroenterology at the Oklahoma City Clinic, Oklahoma City, Oklahoma, USA
- Department of Gastroenterology at the Kansas University, Lawrence, Kansas, USA
- Department of Gastroenterology at the University of Toronto, Toronto, Canada
- Department of Gastroenterology at the St. Paul Gastroenterology, St. Paul, Minnesota, USA
- Department of Gastroenterology at the Atlantic Gastroenterology, New Jersey, USA
- Department of Gastroenterology at the Clinical Research Department, Reid-Rowell, Inc., Baudette, Minnesota, USA
Norton Greenberger
- Department of Gastroenterology at the University of Calgary, Calgary, Canada
- Department of Gastroenterology at the University of Montreal, Montreal, Canada
- Department of Gastroenterology at the Scripps Medical Clinic, La Jolla, California, USA
- Department of Gastroenterology at the Oklahoma City Clinic, Oklahoma City, Oklahoma, USA
- Department of Gastroenterology at the Kansas University, Lawrence, Kansas, USA
- Department of Gastroenterology at the University of Toronto, Toronto, Canada
- Department of Gastroenterology at the St. Paul Gastroenterology, St. Paul, Minnesota, USA
- Department of Gastroenterology at the Atlantic Gastroenterology, New Jersey, USA
- Department of Gastroenterology at the Clinical Research Department, Reid-Rowell, Inc., Baudette, Minnesota, USA
Fred Saibil
- Department of Gastroenterology at the University of Calgary, Calgary, Canada
- Department of Gastroenterology at the University of Montreal, Montreal, Canada
- Department of Gastroenterology at the Scripps Medical Clinic, La Jolla, California, USA
- Department of Gastroenterology at the Oklahoma City Clinic, Oklahoma City, Oklahoma, USA
- Department of Gastroenterology at the Kansas University, Lawrence, Kansas, USA
- Department of Gastroenterology at the University of Toronto, Toronto, Canada
- Department of Gastroenterology at the St. Paul Gastroenterology, St. Paul, Minnesota, USA
- Department of Gastroenterology at the Atlantic Gastroenterology, New Jersey, USA
- Department of Gastroenterology at the Clinical Research Department, Reid-Rowell, Inc., Baudette, Minnesota, USA
Thomas Martin
- Department of Gastroenterology at the University of Calgary, Calgary, Canada
- Department of Gastroenterology at the University of Montreal, Montreal, Canada
- Department of Gastroenterology at the Scripps Medical Clinic, La Jolla, California, USA
- Department of Gastroenterology at the Oklahoma City Clinic, Oklahoma City, Oklahoma, USA
- Department of Gastroenterology at the Kansas University, Lawrence, Kansas, USA
- Department of Gastroenterology at the University of Toronto, Toronto, Canada
- Department of Gastroenterology at the St. Paul Gastroenterology, St. Paul, Minnesota, USA
- Department of Gastroenterology at the Atlantic Gastroenterology, New Jersey, USA
- Department of Gastroenterology at the Clinical Research Department, Reid-Rowell, Inc., Baudette, Minnesota, USA
Joseph Sparr
- Department of Gastroenterology at the University of Calgary, Calgary, Canada
- Department of Gastroenterology at the University of Montreal, Montreal, Canada
- Department of Gastroenterology at the Scripps Medical Clinic, La Jolla, California, USA
- Department of Gastroenterology at the Oklahoma City Clinic, Oklahoma City, Oklahoma, USA
- Department of Gastroenterology at the Kansas University, Lawrence, Kansas, USA
- Department of Gastroenterology at the University of Toronto, Toronto, Canada
- Department of Gastroenterology at the St. Paul Gastroenterology, St. Paul, Minnesota, USA
- Department of Gastroenterology at the Atlantic Gastroenterology, New Jersey, USA
- Department of Gastroenterology at the Clinical Research Department, Reid-Rowell, Inc., Baudette, Minnesota, USA
Ed Prokipchuk
- Department of Gastroenterology at the University of Calgary, Calgary, Canada
- Department of Gastroenterology at the University of Montreal, Montreal, Canada
- Department of Gastroenterology at the Scripps Medical Clinic, La Jolla, California, USA
- Department of Gastroenterology at the Oklahoma City Clinic, Oklahoma City, Oklahoma, USA
- Department of Gastroenterology at the Kansas University, Lawrence, Kansas, USA
- Department of Gastroenterology at the University of Toronto, Toronto, Canada
- Department of Gastroenterology at the St. Paul Gastroenterology, St. Paul, Minnesota, USA
- Department of Gastroenterology at the Atlantic Gastroenterology, New Jersey, USA
- Department of Gastroenterology at the Clinical Research Department, Reid-Rowell, Inc., Baudette, Minnesota, USA
Lowell Borgen
- Department of Gastroenterology at the University of Calgary, Calgary, Canada
- Department of Gastroenterology at the University of Montreal, Montreal, Canada
- Department of Gastroenterology at the Scripps Medical Clinic, La Jolla, California, USA
- Department of Gastroenterology at the Oklahoma City Clinic, Oklahoma City, Oklahoma, USA
- Department of Gastroenterology at the Kansas University, Lawrence, Kansas, USA
- Department of Gastroenterology at the University of Toronto, Toronto, Canada
- Department of Gastroenterology at the St. Paul Gastroenterology, St. Paul, Minnesota, USA
- Department of Gastroenterology at the Atlantic Gastroenterology, New Jersey, USA
- Department of Gastroenterology at the Clinical Research Department, Reid-Rowell, Inc., Baudette, Minnesota, USA

Received 27 March 1986; accepted 1 December 1986.

Abstract

The efficacy and safety of 4-g 5-aminosalicylic acid enemas were assessed in 153 patients with ulcerative colitis involving up to 50 cm of distal colon. Seventy-six patients received active medication and 77 received a placebo. There were 20 dropouts (6 in the active group and 14 in the placebo group) during the study because of insufficient efficacy. After 6 wk of therapy, 48 of the 76 patients (63%) receiving 5-aminosalicylic acid were considered to be “much improved” by the study physician compared to 22 of the 77 patients (29%) on placebo (p = 0.001). A disease activity index based on patient symptoms and sigmoidoscopic appearance was used to assess efficacy. Mean disease activity index declined 55% for patients on 5-aminosalicylic acid and 24% for patients on placebo (p = 0.0001). Analysis of subgroups indicated that patients most likely to respond were those with disease confined to the 20–40 cm from the anus. Response was not affected by concurrent sulfasalazine, but patients requiring concurrent oral steroids had a diminished response. Rapid onset of efficacy was shown by a significant reduction in rectal bleeding within 3 days of treatment initiation. 5-Aminosalicylic acid enemas are well tolerated and are of benefit in the treatment of ulcerative colitis confined to the distal colon.

Abbreviations: 5-ASA, 5-aminosalicylic acid, DAI, disease activity index

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