Short chain fatty acid rectal irrigation for left-sided ulcerative colitis: a randomised, placebo controlled trial.
BACKGROUND
Short chain fatty acid (SCFA) deficiency is associated with colitis in animals and humans, and the mucosal metabolism of these compounds is decreased in ulcerative colitis.


OBJECTIVE
To assess the efficacy of topical SCFA treatment in ulcerative colitis.


METHODS
103 patients with distal ulcerative colitis were entered into a six week, double-blind, placebo controlled trial of rectal SCFA twice daily; patients who were unchanged on placebo were offered SCFA in an open-label extension trial.


RESULTS
Of the 91 patients completing the trial, more patients in the SCFA treated than in the placebo treated group improved (33% v 20%, p = 0.14, NS). Those on SCFA also had larger, but statistically non-significant, reductions in every component of their clinical and histological activity scores. In patients with a relatively short current episode of colitis (< 6 months, n = 42), more responded to SCFA than to placebo (48% v 18%, p = 0.03). These patients also had larger, but statistically non-significant, decreases in their clinical activity index (p = 0.08 v placebo). Every patient who improved used at least five of six of the prescribed rectal SCFA irrigations, whereas only 37% who did not improve were as compliant. In the open-label extension trial, 65% improved on SCFA; these patients also had significant reductions (p < 0.02) in their clinical and histological activity scores.


CONCLUSIONS
Although SCFA enemas were not of therapeutic value in this controlled trial, the results suggest efficacy in subsets of patients with distal ulcerative colitis including those with short active episodes. Prolonged contact with rectal mucosa seems to be necessary for therapeutic benefit.
Breuer
R I
RI
Evanston Hospital, Division of Gastroenterology, Evanston, Illinois 60201, USA.
Soergel
K H
KH
Lashner
B A
BA
Christ
M L
ML
Hanauer
S B
SB
Vanagunas
A
A
Harig
J M
JM
Keshavarzian
A
A
Robinson
M
M
Sellin
J H
JH
Weinberg
D
D
Vidican
D E
DE
Flemal
K L
KL
Rademaker
A W
AW
D000208:Acute Disease; D000287:Administration, Topical; D000328:Adult; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D004311:Double-Blind Method; D004733:Enema; D005232:Fatty Acids, Volatile / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance
D005232:Fatty Acids, Volatile