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Updated: Jun 22, 2026
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Chinese Herbal Retention Enema for the Treatment of Ulcerative Colitis
Published on: May 16, 2025
Beclomethasone dipropionate enema in ulcerative colitis: Is it safe?
Rafael Luboshitzky1, Zoia Rachelis, Elchanan Nussensone
1Endocrine and Gastroenterology Institutes, Haemek Medical Center, Afula, Israel Bruce Rappaport Faculty of Medicine, Technion, Israeli Institute of Technology, Haifa, Israel.
Summary
Beclomethasone dipropionate enemas (Betnesol) significantly suppress the pituitary-adrenal axis in ulcerative colitis patients. Adrenal insufficiency is a risk upon withdrawal, necessitating caution.
Area of Science:
- Endocrinology
- Gastroenterology
Background:
- Ulcerative colitis (UC) management often involves corticosteroids.
- Rectal steroid administration may impact the hypothalamic-pituitary-adrenal (HPA) axis.
Purpose of the Study:
- To assess the pituitary-adrenal (PA) axis reserve in UC patients using beclomethasone dipropionate enemas.
- To evaluate the reversibility of PA axis suppression after enema discontinuation.
Main Methods:
- An adrenocorticotropic hormone (ACTH) stimulation test (1 mcg) was administered to eight UC patients.
- Serum cortisol levels were measured at fasting, 30, and 60 minutes post-ACTH injection.
- Testing was performed during enema treatment and one month after cessation.
Main Results:
- Six patients exhibited suppressed fasting and peak cortisol responses to ACTH.
- One patient had suppressed fasting cortisol, and another showed a blunted ACTH response.
- One month after discontinuing enemas, PA axis function normalized in all but one patient.
Conclusions:
- Beclomethasone dipropionate enemas cause significant PA axis suppression in nearly all UC patients.
- Adrenal insufficiency is a potential complication upon withdrawal of rectal steroids in UC patients.
- Clinical vigilance is crucial during the withdrawal phase of rectal steroid therapy.
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