Prostaglandin synthesis inhibitors in ulcerative colitis: flurbiprofen compared with conventional treatment

It has been suggested that prostaglandins (PGs) play a pathogenetic role in ulcerative colitis (UC) and that treatment with inhibitors of PG synthesis might be of therapeutic benefit. We therefore performed a one-week open trial to compare the effects of oral flurbiprofen with those of conventional therapy with corticosteroids and sulphasalazine, in two groups of patients with active UC. Mean rectal mucosal release of PGE2, measured by in vivo rectal dialysis, fell by 44% (P less than 0.05) after one week's conventional treatment, and the effect of flurbiprofen was not significantly different. However, the patients given flurbiprofen fared significantly worse than those given conventional therapy in respect of rectal mucosal appearance at sigmoidoscopy (P = 0.01), rectal electrical potential difference (p less than 0.01), rectal mucosal sodium absorption (P = 0.01) and rectal bleeding (P less than 0.05). Furthermore, flurbiprofen-treated patients showed significant deteriorations in rectal potential difference (P less than 0.05) and sodium absorption (P less than 0.05). These results do not support the hypothesis that increased mucosal PG production is of major pathogenetic importance in active UC, and suggest that flurbiprofen is unlikely to prove a useful alternative to conventional therapy.