Skip to main content

Advertisement

SpringerLink
Log in

Intermittent therapy with high-dose 5-aminosalicylic acid enemas maintains remission in ulcerative proctitis and proctosigmoiditis

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

PURPOSE: The aim of this study was to compare the efficacy of intermittent therapy with mesalazine enemas and continuous oral mesalazine to maintain remission of distal ulcerative colitis or proctitis. METHODS: Thirt-yeight patients with distal ulcerative colitis (n=17) or ulcerative proctitis (n=21) in clinical, endoscopic, and histologic remission were randomly assigned to receive either oral mesalazine (0.5 g three times/day, Eudragit L coating, n=19) or intermittent therapy with mesalazine enemas (4 g of 5-aminosalicylic acid enema every third night, n=19). Both groups were comparable in regard to sex, age, age at disease onset, extent and duration of disease, number and mode of treatment of previous attacks, and time in remission. Patients were reviewed at the beginning of the study and, subsequently, at two-month intervals for 24 months or until a relapse occurred. At each visit, diaries were reviewed and clinical and laboratory assessments were performed. Sigmoidoscopy was carried out and biopsies were obtained by a blinded observer. Histology was assessed without knowledge of the patient's clinical state or treatment category. RESULTS: At the end of the study, 6 of 19 patients on oral mesalazine (32 percent) and 14 of 19 patients on mesalazine enemas (74 percent) were still in full remission (log rank test: 15.280,P <0.001). Differences in relapse rates between groups were significant even when data were stratified by extent of disease (P <0.01). In the oral group, six and seven patients relapsed at 12 and 24 months, respectively. In the enema group, three and two relapses occurred in the first and second year of the study, respectively. All patients complied with the treatment satisfactorily and there were no dropouts. CONCLUSION: These results suggest that intermittent therapy with mesalazine enemas is more effective than continuous oral mesalazine in maintaining remission in patients with distal ulcerative colitis and proctitis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Morrison LM. Results of treatment of ulcerative colitis with salicylazosulfapyridine. Gastroenterology 1952;21:133.

    PubMed  Google Scholar 

  2. Svartz N. The treatment of ulcerative colitis. Gastroenterology 1954;26:26–8.

    PubMed  Google Scholar 

  3. Moertel OG, Bargen JA. A critical analysis of the use of salicylazosulfapyridine in chronic ulcerative colitis. Ann Intern Med 1959;51:879–89.

    PubMed  Google Scholar 

  4. Misiewicz JJ, Lennard-Jones JE, Connel AM. Controlled trial of sulphasalazine in maintenance therapy for ulcerative colitis. Gut 1964;5:437–42.

    Google Scholar 

  5. Dissanayake AS, Truelove SC. A controlled therapeutic trial of long-term maintenance treatment of ulcerative colitis with sulphasalazine (Salazopyrin). Gut 1973;14:923–6.

    PubMed  Google Scholar 

  6. Azad-Khan AK, Howes DT, Piris J, Truelove SC. Optimum dose of sulphasalazine for maintenance treatment of ulcerative colitis. Gut 1980;21:232–40.

    PubMed  Google Scholar 

  7. Azad Khan AK, Piris J, Truelove SC. An experiment to determine the active therapeutic moiety of sulphasalazine. Lancet 1977;2:892–5.

    PubMed  Google Scholar 

  8. Schroeder KW, Tremaine WJ, Ilstrup DM. Coated 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. N Engl J Med 1987;317:1625–9.

    PubMed  Google Scholar 

  9. Selby WS, Barr GD, Ireland A, Mason CH, Jewell DP. Olsalazine in active ulcerative colitis. BMJ 1985;291:1373–5.

    PubMed  Google Scholar 

  10. Riley SA, Mani V, Goodman MJ, Herd ME, Dutt S, Turnberg LA. Comparison of delayed-release 5-aminosalicylic acid (mesalazine) and sulfasalazine as maintenance treatment for patients with ulcerative colitis. Gastroenterology 1988;94:1383–9.

    PubMed  Google Scholar 

  11. Rutgesrts P. Comparative efficacy of coated oral 5-aminosalicylic acid (Claversal) and sulphasalazine for maintaining remission of ulcerative colitis. Aliment Pharmacol Ther 1989;3:183–91.

    PubMed  Google Scholar 

  12. Campieri M, Lanfranchi GA, Bazzocchi G. Treatment of ulcerative colitis with a high-dose 5-aminosalicylic acid enemas. Lancet 1981;2:271–2.

    Google Scholar 

  13. Basilisco G, Ranzi T, Campanini M, Piodi L, Velio P, Bianchi PA. 5-Aminosalicylic acid or sulphasalazine retention enemas in distal ulcerative colitis. Curr Ther Res 1987;42:910–5.

    Google Scholar 

  14. Sutherland LR, Martin F, Greer S,et al. 5-Aminosalicylic acid enemas in the treatment of distal ulcerative colitis, proctosigmoiditis, and proctitis. Gastroenterology 1987;92:1894–8.

    Google Scholar 

  15. Riley SA, Mani V, Goodman MJ, Herd ME, Dutt S, Turnberg LA. Comparison of delayed-release 5-aminosalicylic acid (mesalazine) and sulfasalazine in treatment of mild to moderate ulcerative colitis relapse. Gut 1983;29:669–74.

    Google Scholar 

  16. Sutherland LR, Martin F. 5-Aminosalicylic acid enemas in the maintenance of remission in distal ulcerative colitis and proctitis. Can J Gastroenterol 1987;1:3–6.

    Google Scholar 

  17. Biddle WI, Greenberger NJ, Swan JT, MvPhee MS, Miner PB. 5-Aminosalicylic acid enemas: effective agent in maintaining remission in left-sided ulcerative colitis. Gastroenterology 1988;94:1075–9.

    Google Scholar 

  18. d'Arienzo A, Panarese A, D'Armiento FP,et al. 5-Aminosalicylic acid suppositories in the maintenance of remission in idiopathic proctitis or proctosigmoiditis: a double-blind placebo-controlled clinical trial. Am J Gastroenterol 1990;85:1079–82.

    PubMed  Google Scholar 

  19. d'Albasio G, Trallori G, Ghetti A,et al. Intermittent therapy with high-dose 5-aminosalicylic acid enemas for maintaining remission in ulcerative proctosigmoiditis. Dis Colon Rectum 1990;33:394–7.

    PubMed  Google Scholar 

  20. Truelove SC, Witts IJ. Cortisone in ulcerative colitis: final report on therapeutic trial. BMJ 1955;2:1041–8.

    Google Scholar 

  21. Friedman LS, Richter JM, Sara EK,et al. 5-Aminosalicylic acid enemas in refractory distal ulcerative colitis: a randomized controlled trial. Am J Gastroenterol 1986;6:412–9.

    Google Scholar 

  22. Peto P, Pike MC, Armitage P. Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. Analysis and examples. Br J Cancer 1977;35:1–39.

    PubMed  Google Scholar 

  23. Ireland A, Jewell DP. Sulphasalazine and the new salicylates. Eur J Gastroenterol Hepatol 1989;1:43–50.

    Google Scholar 

  24. Klotz U. Clinical pharmacology of mesalazine (5-aminosalicylic acid) in chronic inflammatory bowel disease. In: Matern S, ed. Clinical research in gastroenterology. Vol 2. Boston: Kluwer Academic Publishers, 1989:17–30.

    Google Scholar 

  25. d'Albasio G, Trallori G, Gavazzi O,et al. Combined therapy with 5-aminosalicylic tablets and enemas for maintaining remission in ulcerative colitis. Ital J Gastroenterol 1991;23:12–4.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. First Department of Gastroenterology, Evangelismos Hospital, Athens, Greece

    Gerassimos J. Mantzaris M.D., Athanassios Hatzis M.D. & Georgios Triantaphyllou M.D.

  2. Department of Histopathology, Evangelismos Hospital, Athens, Greece

    Kalliopi Petraki M.D. & Charis Spiliadi M.D.

Authors
  1. Gerassimos J. Mantzaris M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Athanassios Hatzis M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kalliopi Petraki M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Charis Spiliadi M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Georgios Triantaphyllou M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Read at the meeting of the First United European Gastroenterology Week, Athens, Greece, September 25 to 30, 1992.

About this article

Cite this article

Mantzaris, G.J., Hatzis, A., Petraki, K. et al. Intermittent therapy with high-dose 5-aminosalicylic acid enemas maintains remission in ulcerative proctitis and proctosigmoiditis. Dis Colon Rectum 37, 58–62 (1994). https://doi.org/10.1007/BF02047216

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02047216

Key words

Search

Navigation