The topical treatment of distal ulcerative colitis

In the absence of a definitively curative medical treatment of distal ulcerative colitis, the major objective of drug therapy is to optimize the quality of life by rapidly suppressing the symptoms of inflammation, without introducing major side effects. Conventional steroids administered topically decrease inflammation in about two-thirds of patients with active distal ulcerative colitis after 3-4 weeks of therapy. However, the risk of the systemic side-effects associated with their prolonged use discourages long-term treatment with these drugs. Enemas containing topically acting steroids are likely to replace conventional steroid enemas in the near future, especially in those patients who need long-term or high-dose therapy. The efficacy, safety and acceptance of rectal formulations of 5-aminosalicylic acid (5-ASA) in the short-term treatment of active ulcerative colitis are now well established. This 5-ASA enemas may be the best initial treatment when the disease is limited to the distal colon. Combination therapy of a topical corticosteroid with 5-ASA enema is a promising treatment for patients with active distal ulcerative colitis. Lignocaine, bismuth subsalicylate and short-chain fatty acids are new drugs under investigation with as yet unproven value. Better information concerning the natural history of the disease and a more careful definition of subgroups of patients may make it possible to personalize dosage, formulation and duration of the active medical treatment for patients with distal ulcerative colitis.