Distal ulcerative colitis refractory to rectal mesalamine: role of transdermal nicotine versus oral mesalamine.
BACKGROUND
Distal ulcerative colitis usually responds to treatment with rectal mesalamine, but the management of refractory cases is poorly defined.


OBJECTIVE
To evaluate the possible therapeutic benefit of transdermal nicotine versus oral mesalamine.


METHODS
Thirty patients with left-sided ulcerative colitis unresponsive to treatment with a mesalamine 4 g enema at bedtime were randomly allocated to additional therapy with either transdermal nicotine 15 mg daily or oral mesalamine 800 mg tid for four weeks. Clinical remission was evaluated by Rachmilewitz's activity index and confirmed by sigmoidoscopy.


RESULTS
Remission was observed in 12 of 15 patients receiving additional treatment with nicotine and in five of 15 patients receiving additional treatment with oral mesalamine (P=0.027).


CONCLUSIONS
The addition of transdermal nicotine to treatment with mesalamine enemas is significantly superior to combined therapy with oral and rectal mesalamine in patients with distal ulcerative colitis refractory to rectal mesalamine alone.
Guslandi
Mario
M
San Raffaele University Hospital, Milan, Italy. guslandi.mario@hsr.it
Frego
Roberto
R
Viale
Edi
E
Testoni
Pier Alberto
PA
D000279:Administration, Cutaneous; D000284:Administration, Oral; D000285:Administration, Rectal; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D004341:Drug Evaluation; D005260:Female; D006801:Humans; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use*; D008875:Middle Aged; D009538:Nicotine / Q000627:therapeutic use; D018722:Nicotinic Agonists / Q000627:therapeutic use; D012720:Severity of Illness Index; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D018722:Nicotinic Agonists; D019804:Mesalamine; D009538:Nicotine