Retrograde spread of 5-aminosalicylic acid enemas in patients with active ulcerative colitis

Abstract

In an attempt to know the exact retrograde spread of high-dosage 5-aminosalicylic acid enemas, we have studied eight patients with active left-sided colitis, by adding a small amount of barium sulfate to the enemas and by checking the spread radiologically after 15 minutes, 1 hour, and 6 hours. Four grams of 5-aminosalicylic acid in 100-ml enemas and 4 gm in 200-ml enemas were used. The same experiment was repeated in a subsequent attack, with enemas labeled with technetium-99m and checked by scintiscans in five of these patients. We always have observed a volume-dependent spread of enemas but, interestingly, in the patients studied with technetium-99m there was always a wider spread than that which was detected with barium enemas. In all five patients, 100-ml enemas reached the splenic flexure. In two patients with total colitis, a progression of 100-ml technetium-99m enemas was performed in the transverse colon, but the maximum opacity remained in the left side. We can conclude that 4 gm of 5-aminosalicylic acid in 100-ml enemas can be suitable for treating patients with left-sided colitis, and will represent a valid addition for patients with more extensive colitis.

Retrograde colonic spread of a new mesalazine rectal enema in patients with distal ulcerative colitis

“…11,12 In addition, administration of enema solutions has some disadvantages due to problems with retention, which may interfere negatively with compliance to the topical treatment. 9 Colonic mesalazine foams provide a rapid and homogeneous distribution in the colon.…”

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“…By increasing the volume of the enemas from 100 to 200 ml, a significantly increased fraction of dose was absorbed. This demonstrates the effect on absorption of an enema with a larger volume probably due to a more extensive retrograde spread (20,118,130). In patients with active UC the absorption was found to be significantly lower and it was suggested that this either was due to shorter enemaretention-time, or a lower drug-permeability of the mucosa in active disease.…”

New steroids and new salicylates in inflammatory bowel disease: a critical appraisal

“…Combination treatment with oral and rectal mesalazine is more effective than a single agent and is useful in patients with refractory disease. [8][9][10][11][12][13][14][15][16][17] Topical 5-ASA also has an important role in maintenance of remission. While dose ranging trials for topical therapy have not been performed, dose interval trials have shown a dose interval benefit between alternate night dosing or every third night dosing.…”