title: Nicotine enemas for active Crohn's colitis: an open pilot study.
abstract: BACKGROUND
  Smoking has a detrimental effect in Crohn's disease (CD), but this may be due to factors in smoking other than nicotine. Given that transdermal nicotine benefits ulcerative colitis (UC), and there is a considerable overlap in the treatment of UC and CD, the possible beneficial effect of nicotine has been examined in patients with Crohn's colitis.
  
  
  OBJECTIVE
  To assess the efficacy and safety of nicotine enemas in active Crohn's colitis. Patients. Thirteen patients with active rectosigmoid CD; 3 patients were excluded because they received antibiotics.
  
  
  METHODS
  Subjects were given 6 mg nicotine enemas, each day for 4 weeks, in an open pilot study. At the beginning and end of the trial, a Crohn's disease activity index (CDAI) score was calculated, sigmoidoscopy was performed, and haematological inflammatory markers measured.
  
  
  RESULTS
  Mean CDAI decreased from 202 to 153-the score was reduced in 6 patients, unchanged in 3, and increased in one. Frequency of bowel movements decreased in 8 patients and the sigmoidoscopy grade was reduced in 7. Mean C-reactive protein decreased from 22.0 to 12.3 mg/L. There were no withdrawals due to adverse events.
  
  
  CONCLUSIONS
  In this relatively small study of patients with active Crohn's colitis, 6 mg nicotine enemas appeared to be of clinical benefit in most patients. They were well tolerated and safe.
authors.affiliation: Department of Gastroenterology, Cardiff and Vale NHS Trust, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK.
authors.forename: J R
authors.initials: JR
authors.lastname: Ingram
authors.forename: J
authors.initials: J
authors.lastname: Rhodes
authors.forename: B K
authors.initials: BK
authors.lastname: Evans
authors.forename: G A O
authors.initials: GA
authors.lastname: Thomas
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