Comparison of bismuth citrate and 5-aminosalicylic acid enemas in distal ulcerative colitis: a controlled trial.
An enema that contained a complex of bismuth citrate and polyacrylate was compared with 5-aminosalicylic acid (5-ASA) enemas for treatment of distal ulcerative colitis. The multicentre trial involving 63 patients was randomised and double blind with enemas given over four weeks; clinical, sigmoidoscopic, and histological assessments were made. Improvements were seen in both treatment groups. Clinical remission was seen in 18 of 32 patients treated with 5-ASA and 12 of 31 patients treated with bismuth citrate-carbomer (chi 2 1.94; p = 0.16). Sigmoidoscopic remission occurred in 20 of 32 patients in the 5-ASA group and 15 of 31 patients given bismuth (chi 2 1.27; p = 0.26). Improvement of rectal biopsy histology by at least one grade was seen in 16 of 32 patients in the 5-ASA group and 14 of 31 patients with bismuth (chi 2 0.15; p = 0.70). Analysis of covariance gave no significant difference between groups, although there was a trend favouring 5-ASA. There was no evidence of bismuth accumulation during the trial. Bismuth enemas may offer a new therapeutic option in distal ulcerative colitis.
Department of Gastroenterology, University Hospital of Wales, Cardiff.
R D
RD
Pullan
S
S
Ganesh
V
V
Mani
J
J
Morris
B K
BK
Evans
G T
GT
Williams
J
J
Rhodes
D000328:Adult; D000636:Aminosalicylic Acids / Q000008:administration & dosage*; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000473:pathology; D004311:Double-Blind Method; D004733:Enema; D005260:Female; D006801:Humans; D008297:Male; D019804:Mesalamine; D009942:Organometallic Compounds / Q000008:administration & dosage*; D012007:Rectum / Q000473:pathology
D000636:Aminosalicylic Acids; D000897:Anti-Ulcer Agents; D009942:Organometallic Compounds; D019804:Mesalamine; C002791:bismuth tripotassium dicitrate