title: Topical therapy is underused in patients with ulcerative colitis.
abstract: The availability of new topical preparations for the treatment of left sided ulcerative colitis offers a therapy optimization for many patients. Rectal application of steroids and 5-aminosalicylic acid (5-ASA) is associated with fewer side effects and has a higher therapeutic efficacy in left-sided colitis as compared to a systemic therapy. Therefore, we were interested in the use of topical therapy in patients with ulcerative colitis. The key question was whether topical treatment is more frequently used than oral therapy in patients with proctitis and left sided colitis. Data of 800 patients of the Swiss IBD cohort study were analyzed. Sixteen percent of patients of the cohort had proctitis, 21% proctosigmoiditis and 41% pancolitis. Topical therapy with 5-ASA or corticosteroids was given in 26% of patients with proctitis, a combined systemic and topical treatment was given in 13%, whereas systemic treatment with 5-ASA without topical treatment was given in 29%. Proportion of topical drug use decreased with respect to disease extension from 39% for proctitis to 13.1% for pancolitis (P=0.001). Patients with severe colitis received a significantly higher dose of topical 5-ASA than patients in remission. Side effects of topical or systemic 5-ASA or budesonide treatment were less frequently seen compared to other medications. Topical treatment was frequently stopped over time. The quality of life was the same in patients with limited disease compared to patients with pancolitis. Topical treatment in proctitis patients was underused in Switzerland. Since topical treatment is safe and effective it should be used to a larger extend.
authors.affiliation: Gastroenterologie, Spital Netz Bern Tiefenau, Bern, Switzerland; Inselspital University of Bern, Gastroenterology Bern, Switzerland. Electronic address: frank.seibold@spitalnetzbern.ch.
authors.forename: F
authors.initials: F
authors.lastname: Seibold
authors.affiliation: Institute of Social & Preventive Medicine, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.
authors.forename: N
authors.initials: N
authors.lastname: Fournier
authors.affiliation: Gastroenterologie, Universitätsspital Basel, Basel, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Beglinger
authors.affiliation: Gastroenterologie, Hôpital neuchâtelois, Neuchâtel, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Mottet
authors.affiliation: Institute of Social & Preventive Medicine, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.
authors.forename: V
authors.initials: V
authors.lastname: Pittet
authors.affiliation: Gastroenterologie und Hepatologie, Universitätsspital Zürich, Zürich, Switzerland.
authors.forename: G
authors.initials: G
authors.lastname: Rogler
mesh_terms: D000284:Administration, Oral; D000285:Administration, Rectal; D000287:Administration, Topical; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D019819:Budesonide / Q000008:administration & dosage; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D004733:Enema / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D008297:Male; D019804:Mesalamine / Q000008:administration & dosage*; D008875:Middle Aged; D011349:Proctitis / Q000188:drug therapy*; D012720:Severity of Illness Index; D013557:Switzerland; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D007155:Immunologic Factors; D014409:Tumor Necrosis Factor-alpha; D019804:Mesalamine; D019819:Budesonide
keywords: Enema; Proctitis; Quality of life; Rectal foam; SIBDCS; Swiss Inflammatory Bowel Disease Cohort study.; Topical therapy; Ulcerative colitis