title: Topical butyrate improves efficacy of 5-ASA in refractory distal ulcerative colitis: results of a multicentre trial.
abstract: BACKGROUND
  The treatment of distal ulcerative colitis, refractory to conventional 5-ASA/steroid treatment, is still a matter of debate. The present study aimed at confirming, with adequate statistical power, previous data indicating the usefulness of topical butyrate and 5-ASA in the treatment of this condition.
  
  
  METHODS
  Double-blind, placebo-controlled, multicentre study. A total of 51 patients with distal (< 65 cm) ulcerative colitis, refractory to topical 5-ASA/cortisone, were randomly allocated to receive topical 5-ASA 2 g and 80 mM L-1 sodium-butyrate bid (Group A; 24 patients) or 5-ASA 2 g and 80 mL saline bid (Group B; 27 patients) for 6 weeks. Sigmoidoscopy with biopsies, as well as clinical and laboratory evaluations, were carried out at enrollment and at the end of the trial. Primary endpoints: remission or marked improvement in endoscopic, histologic and clinical findings.
  
  
  RESULTS
  Most parameters showed a significant improvement vs. baseline in both groups. Remission in six patients and improvement in 12 patients in Group A vs. one remission and 13 with improvement in Group B (P < 0.05). A significant difference in favour of Group A was recorded regarding the number of bowel movements (P < 0.01), urgency (P < 0.05) and the patients' self evaluation (P < 0.01).
  
  
  CONCLUSIONS
  The combined treatment with topical butyrate and 5-ASA is significantly more effective than 5-ASA alone in the management of refractory distal colitis. Further improvements in the treatment of refractory distal ulcerative colitis may be feasible based on the identification of patient subgroups and the association of two or more active drugs. Butyrate may well be one of them.
authors.affiliation: Dipartmento Scienze Cliniche, Università di Roma La Sapienza, Rome, Italy. vernia@uniroma1.it
authors.forename: P
authors.initials: P
authors.lastname: Vernia
authors.forename: V
authors.initials: V
authors.lastname: Annese
authors.forename: G
authors.initials: G
authors.lastname: Bresci
authors.forename: G
authors.initials: G
authors.lastname: d'Albasio
authors.forename: R
authors.initials: R
authors.lastname: D'Incà
authors.forename: S
authors.initials: S
authors.lastname: Giaccari
authors.forename: M
authors.initials: M
authors.lastname: Ingrosso
authors.forename: C
authors.initials: C
authors.lastname: Mansi
authors.forename: G
authors.initials: G
authors.lastname: Riegler
authors.forename: D
authors.initials: D
authors.lastname: Valpiani
authors.forename: R
authors.initials: R
authors.lastname: Caprilli
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D002087:Butyrates / Q000627:therapeutic use*; D002908:Chronic Disease; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use*; D008875:Middle Aged
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents; D002087:Butyrates; D019804:Mesalamine