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A Comparative Review of Topical Therapies for Inflammatory Bowel Disease

  • Review Article
  • Drug Class Overview
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Summery

Topical therapy, although first recognised in the treatment of left-sided colitis in 1956, has only recently come to be viewed as the optimal first line therapy for patients with distal colitis. Sulfasalazine enemas, mesalazine (5-aminosalicylic acid) enemas/foam and 4-aminosalicylic acid enemas have impressive response rates of 70 to 80% in active disease as well as efficacy in the maintenance of remission. Suppository formulations are as effective as enemas for patients with proctitis, and have the advantage of ease and comfort of use. Corticosteroid enemas are as effective as mesalazine enemas in treating active colitis. Concerns about systemic absorption of traditional topical corticosteroids have led to the development of newer topical corticosteroids with fewer systemic adverse effects. Several novel topical agents, including short-chain fatty acids, sodium cromoglycate (cromolyn sodium), sucralfate, bismuth citrate, lidocaine (lignocaine) and interleukin-10, show promise as future therapies.

The armamentarium for the medical treatment of inflammatory bowel disease is no longer limited to the oral forms of sulfasalazine, mesalazine and corticosteroids. Topical therapy has several advantages over oral therapy, including fewer adverse effects, better response rates and delivery of the active agent in high concentrations to the affected area. Therefore, topical treatment should be considered the treatment of choice for proctitis and distal colitis.

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  1. Division of Gastroenterology, Department of Medicine, Beth Israel Hospital, Harvard Medical School, Boston, Massachusetts, USA

    Samir A. Shah & Mark A. Peppercorn

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Shah, S.A., Peppercorn, M.A. A Comparative Review of Topical Therapies for Inflammatory Bowel Disease. Clin. Immunother. 6, 117–129 (1996). https://doi.org/10.1007/BF03259508

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