Comparison of oral with rectal mesalazine in the treatment of ulcerative proctitis

Gionchetti, Paolo; Rizzello, Fernando; Venturi, Alessandro; Ferretti, Maurizio; Brignola, C.; Miglioli, M.; Campieri, Massimo

doi:10.1007/bf02236902

Cited by 138 publications

(105 citation statements)

References 17 publications

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“…In a 4-week randomized, single-blinded study comparing pH-dependent oral mesalazine 2.4 g/day (800 mg tablet taken three times per day) with rectal mesalazine suppository 2.4 g/day (400 mg suppository administered 3 times per day), clinical, endoscopical, and histological remission rates were significantly higher with mesalazine suppository than with oral mesalazine [20]. Mesalazine suppository 1 g at bedtime and 500 mg twice daily were equally effective for patients with ulcerative proctitis [21].…”

Section: Treatmentmentioning

confidence: 99%

Optimized Management of Ulcerative Proctitis: When and How to Use Mesalazine Suppository

et al. 2018

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Background: Ulcerative proctitis, one of the disease types of ulcerative colitis, is considered one of the initial manifestations of ulcerative colitis. Prevention of aggravation of ulcerative proctitis is important for improving the prognosis of ulcerative colitis. Here we reviewed the epidemiology, diagnosis, and management of ulcerative proctitis. Summary: The number of patients with ulcerative proctitis is increasing. Disease extension occurs in many patients with ulcerative proctitis. Differential diagnosis from other chronic proctitis is important and should be performed based on the clinical history and endoscopical and histological features. Mesalazine suppository has been the first-line therapy for patients with ulcerative proctitis because of its high effectiveness and safety. Topical treatment of ulcerative proctitis, particularly using mesalazine suppository has been underused in clinical practice. Key Messages: Mesalazine suppositories are more effective than dose intensification of oral mesalazine for relapsed patients with maintenance dose of oral mesalazine. However, low adherence to rectal mesalazine has hindered remission in patients with ulcerative proctitis.

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Section: Treatmentmentioning

confidence: 99%

Optimized Management of Ulcerative Proctitis: When and How to Use Mesalazine Suppository

et al. 2018

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“…A 4-week, randomized, single-blind trial in UP patients showed that mesalazine suppositories were more effective than oral mesalazine both in decreasing disease activity and in increasing the rate of histologic remission, at 2-and 4-week follow-up [16]. On the other hand, Kam et al [17] described a similar clinical efficacy of oral versus rectal mesalazine in the same clinical setting.…”

Section: Discussionmentioning

confidence: 77%

Multi Matrix System Mesalazine Plus Rectal Mesalazine in the Treatment of Mild to Moderately Active Ulcerative Proctitis

Cuomo

Sgambato

D’Auria

et al. 2018

Dig Dis

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Background: Mesalazine 1 g suppository/die is used for mild to moderately active ulcerative proctitis (UP). Whether addiction of Multi Matrix System (MMX) mesalazine increases the remission rate of UP and prevents proximal extension of disease is unknown. Methods: This is a retrospective study on 116 outpatients with UP who had been treated with one of the following regimens: (1) MMX mesalazine 1.2 g/die plus mesalazine suppositories for 8 ± 2 weeks and, subsequently, MMX mesalazine 1.2 g/die plus rectal mesalazine 1 g every other day for at least 6 months; (2) mesalazine 1 g suppositories/die alone for 8 ± 2 weeks and, subsequently, rectal mesalazine 1 g every other day for 6 more months. Patients were evaluated clinically at 2 months (±2 weeks) and endoscopically at 6 months (±2 weeks). For categorical variables, Pearson chi-square test was used. Results: A total of 46 of 55 patients (84%) on combined therapy and 49 of 61 patients (80%) on rectal mesalazine reached clinical remission (p > 0.05; OR 0.79, 95% CI 0.30–2.07). At 6 months follow-up, proximal extension of disease was observed in 7 of 55 (14%) patients on combined therapy and in 18 of 61 (29%) patients on rectal mesalazine alone (p < 0.05; OR 2.87, 95% CI 1.09–7.53). Conclusions: Oral MMX mesalazine plus rectal mesalazine combined treatment is associated with prevention of proximal extension of the disease compared with rectal mesalazine alone.

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“…In fact, scintigraphic studies have demonstrated that the drug is consistently delivered to the rectum and distal sigmoid colon [2,3], and that suppositories are as effective as enemas but are better tolerated and preferred by patients [4]. Recently, 5-ASA suppositories (400 mg t.i.d) have been shown to produce earlier and significantly better results than oral mesalazine (2.4 g daily) in the treatment of active proctitis [5].…”

Section: Management Of Mild-to-moderate Ulcerative Colitismentioning

confidence: 99%

Standard Treatment of Ulcerative Colitis

Gionchetti

Rizzello

Habal

et al. 2003

Dig Dis

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Ulcerative colitis (UC) is an idiopathic, chronic inflammation of the colon which may present with a range of mild to severe symptoms. The disease may be localized to the rectum or can be more extensive and involve the left side of the colon or the whole colon. Treatment in UC is directed towards inducing and maintaining remission of symptoms and mucosal inflammation. The key parameters to be assessed for the most appropriate treatment are the severity and extent of the inflammation. Meta-analyses of published trials have shown that topical treatment with 5-aminosalicylic acid (5-ASA) is the treatment of choice in active distal mild-to-moderate UC. Oral aminosalicylates are effective in both distal and extensive mild-to-moderate disease, but in distal disease, the rates of remission are lower than those obtained with topical 5-ASA. New steroids, such as budesonide and beclomethasone dipropionate (BDP), administered as enemas, constitute an alternative to 5-ASA therapy. In some studies, these have been shown to be as effective as conventional steroids but with significantly lower inhibition of plasma cortisol levels. Patients with unresponsive disease or those with more severe presentation will require oral corticosteroids and sometimes intravenous therapy. Approximately 10% of patients with unresponsive UC have severe attacks requiring hospitalization. Patients with severe disease should be managed jointly by a medical and surgical team, and intensive intravenous treatment should be started with high-dose steroids. Early recognition of failure of therapy will allow the introduction of immunosuppressive therapy with intravenous cyclosporine. Patients who respond are shifted to oral cyclosporine associated with azathioprine/6-mercaptopurine, whereas those who fail will require proctocolectomy. Oral aminosalicylates are the first-line therapy in maintenance of remission. Topical 5-ASA may play a role in distal disease. Patients who are steroid dependent can be started on azathioprine or 6-mercaptopurine although it may take up to 3 months for the treatment to become effective. They may have reversible immediate side effects, such as pancreatitis or bone marrow suppression, which disappear upon discontinuation of therapy. Close monitoring of these hematologic and biochemical parameters will improve safety. The use of biologic therapy with infliximab in more severe disease has not been established.

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Comparison of oral with rectal mesalazine in the treatment of ulcerative proctitis

Abstract: Results of this study indicate that treatment with mesalazine suppositories produces earlier and significantly better results than oral mesalazine in the treatment of active ulcerative proctitis.

Cited by 138 publications

References 17 publications

Optimized Management of Ulcerative Proctitis: When and How to Use Mesalazine Suppository

Optimized Management of Ulcerative Proctitis: When and How to Use Mesalazine Suppository

Multi Matrix System Mesalazine Plus Rectal Mesalazine in the Treatment of Mild to Moderately Active Ulcerative Proctitis

Standard Treatment of Ulcerative Colitis

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