Proctocolitis unresponsive to conventional therapy. Response to 5-aminosalicylic acid enemas

We report results of a prospective study of daily 5-ASA enema therapy in patients with proctocolitis that was unresponsive to conventional therapy. Forty-seven patients with active colonic inflammation distal to the splenic flexure have been followed for three months to three years. Rapid improvement was noted within three months in 41 of 47 (87%) patients, while six failed therapy. Of the 41 patients responding to therapy, 39 achieved complete remission. Nineteen patients have relapsed at least once following discontinuation of 5-ASA, but 23 of 25 (92%) relapse episodes responded to a course of 5-ASA therapy. Complications of 5-ASA therapy were limited to hemorrhoidal irritation and local perianal injury. We conclude that 5-ASA enema is effective in inducing remission in patients with proctocolitis unresponsive to conventional therapy.