A COMPARATIVE REVIEW OF TOPICAL THERAPIES FOR INFLAMMATORY BOWEL-DISEASE

Topical therapy, although first recognised in the treatment of left-si ded colitis in 1956, has only recently come to be viewed as the optima l first line therapy for patients with distal colitis. Sulfasalazine e nemas, mesalazine (5-aminosalicylic acid) enemas/foam and 4-aminosalic ylic acid enemas have impressive response rates of 70 to 80% in active disease as well as efficacy in the maintenance of remission. Supposit ory formulations are as effective as enemas for patients with proctiti s, and have the advantage of ease and comfort of use. Corticosteroid e nemas are as effective as mesalazine enemas in treating active colitis . Concerns about systemic absorption of traditional topical corticoste roids have led to the development of newer topical corticosteroids wit h fewer systemic adverse effects, Several novel topical agents, includ ing short-chain fatty acids, sodium cromoglycate (cromolyn sodium), su cralfate, bismuth citrate, lidocaine (lignocaine) and interleukin-10, show promise as future therapies. The armamentarium for the medical tr eatment of inflammatory bowel disease is no longer limited to the oral forms of sulfasalazine, mesalazine and corticosteroids. Topical thera py has several advantages over oral therapy, including fewer adverse e ffects, better response rates and delivery of the active agent in high concentrations to the affected area. Therefore, topical treatment sho uld be considered the treatment of choice for proctitis and distal col itis.