Nicotine enemas for active ulcerative colitis--a pilot study.
BACKGROUND
Since transdermal nicotine is of value in the treatment of active ulcerative colitis but is often associated with side-effects, an alternative in the form of topical therapy with nicotine enemas has been developed.


METHODS
In an open study, 22 patients with active colitis, all non-smokers, were asked to take a 100 mL enema containing 6 mg of nicotine every night for 4 weeks. Pre-trial treatment using mesalazine (n = 16), oral prednisolone (8), cyclosporin (1) and azathioprine (1) was kept constant for the month prior to assessment and during the study period. Symptoms, with stool frequency, were recorded on a diary card and an endoscopy was performed with rectal biopsy at the beginning of the study and after 4 weeks.


RESULTS
Seventeen of the 22 patients completed 1 month of treatment. Mean duration of relapse was 29 weeks, range 3-94. Sixteen of 17 improved their St Mark's score. Urgency and stool frequency improved in 12 patients, sigmoidoscopic and histological scores in 10. Three patients had a full remission of symptoms with normal sigmoidoscopy. Six of 10 with a partial response continued with the enemas for a second month and five showed further improvement with full remission in two. The enema appeared effective when added to conventional treatment and produced few side-effects.


CONCLUSIONS
Topical nicotine therapy for ulcerative colitis may have a place in future management, but controlled studies are needed.
Green
J T
JT
Department of Gastroenterology, University Hospital of Wales, Cardiff, UK.
Thomas
G A
GA
Rhodes
J
J
Williams
G T
GT
Evans
B K
BK
Russell
M A
MA
Feyerabend
C
C
Rhodes
P
P
Sandborn
W J
WJ
D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000473:pathology; D004733:Enema; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000008:administration & dosage*; D018722:Nicotinic Agonists / Q000008:administration & dosage*; D012812:Sigmoidoscopy
D018722:Nicotinic Agonists; D009538:Nicotine