Journal of Gastroenterology

, Volume 53, Issue 6, pp 799–800 | Cite as

A proposed treatment algorithm for mild to moderate ulcerative colitis—with an emphasis on budesonide foam and mucosal healing

  • Juris Pokrotnieks
  • Stanislav Sitkin
Letter to the Editor

We read with great interest the paper recently published by Naganuma et al. [1] on the budesonide foam in mild to moderate ulcerative colitis (UC). Indeed, second-generation corticosteroids, such as budesonide, can become a reliable “intermediate layer” between mesalazine and systemic corticosteroids in the UC treatment pyramid. In this regard, we would like to supplement the current treatment algorithm considering data from rectal budesonide studies [1, 2, 3, 4, 5, 6].

Earlier, two large studies have shown similar efficacy and safety of budesonide foam compared with hydrocortisone foam [2], as well as compared with budesonide enema in patients with distal UC [3]. Furthermore, in the second study, most patients (84%) preferred foam because of its better tolerability and easier application [3].

More recently, two large, randomized, placebo-controlled, phase 3 studies demonstrated that a significantly greater percentage of patients with active, mild to moderate ulcerative proctitis or...


Compliance with ethical standards

Conflict of Interest

The authors declare that they have no conflict of interest. Authors must indicate whether or not they have/had a financial relationship (within the last 3 years) with any organization that sponsored the research. They should also confirm that they have full control of all primary data and they agree to allow the journal to review their data if requested.


  1. 1.
    Naganuma M, Aoyama N, Tada T, et al. Complete mucosal healing of distal lesions induced by twice-daily budesonide 2-mg foam promoted clinical remission of mild-to-moderate ulcerative colitis with distal active inflammation: double-blind, randomized study. J Gastroenterol. 2018;53(4):494–506. Scholar
  2. 2.
    Bar-Meir S, Fidder HH, Faszczyk M, et al. Budesonide foam vs. hydrocortisone acetate foam in the treatment of active ulcerative proctosigmoiditis. Dis Colon Rectum. 2003;46(7):929–36.CrossRefPubMedGoogle Scholar
  3. 3.
    Gross V, Bar-Meir S, Lavy A, et al. Budesonide foam versus budesonide enema in active ulcerative proctitis and proctosigmoiditis. Aliment Pharmacol Ther. 2006;23:303–12.CrossRefPubMedGoogle Scholar
  4. 4.
    Sandborn WJ, Bosworth B, Zakko S, et al. Budesonide foam induces remission in patients with mild to moderate ulcerative proctitis and ulcerative proctosigmoiditis. Gastroenterology. 2015;148(4):740–50.e2.CrossRefGoogle Scholar
  5. 5.
    Bosworth BP, Sandborn WJ, Rubin DT, Harper JR. Baseline oral 5-ASA use and efficacy and safety of budesonide foam in patients with ulcerative proctitis and ulcerative proctosigmoiditis: analysis of 2 phase 3 studies. Inflamm Bowel Dis. 2016;22:1881–6.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Naganuma M, Aoyama N, Suzuki Y, et al. Twice-daily budesonide 2-mg foam induces complete mucosal healing in patients with distal ulcerative colitis. J Crohns Colitis. 2016;10(7):828–36.CrossRefPubMedGoogle Scholar
  7. 7.
    Shah SC, Colombel JF, Sands BE, Narula N. Mucosal healing is associated with improved long-term outcomes of patients with ulcerative colitis: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2016;14(9):1245–55.e8.Google Scholar

Copyright information

© Japanese Society of Gastroenterology 2018

Authors and Affiliations

  1. 1.Department of Internal DiseasesRīga Stradiņš UniversityRigaLatvia
  2. 2.Centre of Gastroenterology, Hepatology and NutritionPauls Stradiņš Clinical University HospitalRigaLatvia
  3. 3.Department of Internal Diseases, Gastroenterology and DieteticsNorth-Western State Medical University named after I.I. MechnikovSt. PetersburgRussia
  4. 4.State Research Institute of Highly Pure BiopreparationsSt. PetersburgRussia

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