Oral budesonide significantly improves water absorption in patients with ileostomy for Crohn disease.
BACKGROUND
In addition to their anti-inflammatory effects, steroids influence electrolyte and water transport systems in the intestinal mucosa. This study analysed the effect of the topically acting glucocorticoid budesonide on ileostomy output in patients with Crohn disease.


METHODS
Oral budesonide (3 mg/three times daily for 8 days; n = 20) was compared to placebo (n = 20) in a double-blind design using matched-pair randomization according to ileal resection length in patients without detectable inflammatory activity. Under controlled hospital conditions, absolute output volumes were measured and response was defined as a reduction in intestinal output of > 25% compared to pretreatment conditions.


RESULTS
In the treatment group, we observed an absolute decrease in median intestinal output from 1,240 ml to 865 ml (30.2%), compared to 0.3% under placebo (from 950 ml to 947.5 ml). Response was documented in 60% (12/20 patients) in the treatment group compared to no response under placebo (P < 0.0001). While both treatment groups showed similar absolute median reductions (400 ml with ileal resection < or = 20 cm and 405 ml with ileal resection > 20 cm), the relative reduction (response rate) was lower in the subgroup of an ileal resection > 20 cm (36%) due to the greater increase in output secondary to the loss of ileum.


CONCLUSIONS
These data support the assumption that the absorptive capacity of the intestinal mucosa for water may be improved by topically acting steroids and suggest that this occurs independently of their anti-inflammatory effect.
Ecker
K W
KW
Surgical and Medical Dept., University of Saarland, Homburg/Saar, Germany. checker@uni-saarland.de
Stallmach
A
A
Seitz
G
G
Gierend
M
M
Greinwald
R
R
Achenbach
U
U
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001792:Blood Platelets / Q000187:drug effects; D001799:Blood Sedimentation / Q000187:drug effects; D001834:Body Water / Q000378:metabolism*; D019819:Budesonide / Q000008:administration & dosage / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000187:drug effects; D003424:Crohn Disease / Q000378:metabolism* / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007081:Ileostomy; D007408:Intestinal Absorption / Q000187:drug effects*; D007413:Intestinal Mucosa / Q000187:drug effects / Q000378:metabolism; D007962:Leukocytes / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D019819:Budesonide; D002097:C-Reactive Protein