Nicotine enemas for active Crohn's colitis: an open pilot study.
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.
Ingram
J R
JR
Department of Gastroenterology, Cardiff and Vale NHS Trust, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK.
Rhodes
J
J
Evans
B K
BK
Thomas
G A O
GA
Ann Intern Med. 1997 Mar 1;126(5):364-71
9054280
Br Med J. 1956 Jun 9;1(4979):1315-8
13316140
Gastroenterology. 1990 May;98(5 Pt 1):1123-8
2323505
Lancet. 1989 Nov 4;2(8671):1057-62
2572794
N Engl J Med. 1994 Mar 24;330(12):811-5
8114833
Br Med J (Clin Res Ed). 1984 Oct 13;289(6450):954-6
6435736
Dig Dis Sci. 1989 Dec;34(12):1841-54
2598752
Inflamm Bowel Dis. 2000 Feb;6(1):8-15
10701144
J Immunol. 2001 Dec 1;167(11):6518-24
11714820
Aliment Pharmacol Ther. 1997 Aug;11(4):663-71
9305473
Aliment Pharmacol Ther. 2000 Nov;14(11):1429-34
11069313
Br Med J (Clin Res Ed). 1982 Mar 6;284(6317):706
6802296
Gastroenterology. 1976 Mar;70(3):439-44
1248701
Inflamm Bowel Dis. 2005 Dec;11(12):1092-6
16306772
Clin Exp Immunol. 1990 Aug;81(2):301-5
2117510
Nature. 2001 May 31;411(6837):599-603
11385576
Eur J Gastroenterol Hepatol. 1999 Nov;11(11):1299-304
10563544
J Immunol. 1996 Apr 1;156(7):2384-90
8786295
Am J Gastroenterol. 1996 Aug;91(8):1571-8
8759664
N Engl J Med. 1987 Mar 19;316(12):707-10
3821808
Scand J Gastroenterol Suppl. 1989;170:2-6; discussion 16-9
2617184
N Engl J Med. 1983 Feb 3;308(5):261-3
6848937
Aliment Pharmacol Ther. 1997 Oct;11(5):859-63
9354193
Ital J Gastroenterol Hepatol. 1998 Jun;30(3):260-5
9759592
Gut. 1964 Oct;5:437-42
14218553
Nature. 2003 Jan 23;421(6921):384-8
12508119
Cochrane Database Syst Rev. 2004 Oct 18;(4):CD004722
15495126
Clin Gastroenterol Hepatol. 2005 Nov;3(11):1107-14
16271342