TREATMENT OF LEFT-SIDED ULCERATIVE-COLITIS WITH BUTYRATE ENEMAS - A CONTROLLED TRIAL

Background: The colonic mucosa is highly dependent upon the presence o f luminal nutrients. This dependence is most marked in the distal colo n. The major luminal nutrients are short chain fatty acids that are pr oduced as a by-product of colonic fermentation of carbohydrates. Butyr ate appears to be the short chain fatty acid most avidly metabolized b y the colonic mucosa, It has been suggested that ulcerative colitis is , at least in part, related to an energy deficiency state of the colon ic mucosa which may be secondary to impaired short chain fatty acid pr oduction, uptake or utilization. The objective of this study was to de termine if butyrate given as enema therapy is effective in the treatme nt of active distal ulcerative colitis. Methods: Thirty-eight patients with distal ulcerative colitis were randomly assigned to receive nigh tly butyrate (n = 19) or saline/placebo (n = 19) enemas. Butyrate enem as consisted of 60 mL of 80 mM sodium butyrate titrated to a pH of 7.0 , Patients were assessed clinically and endoscopically at baseline and at 3 and 6 weeks follow-up, Pre- and post-treatment mucosal biopsies were assessed histologically. Response to therapy was determined by ch anges in a 12-point clinical disease activity index score based on pat ient symptoms, endoscopic mucosal appearance and physicians' global as sessment, Results: Clinical improvement was noted in seven of 19 (37%) butyrate-treated patients and nine of 19 (47%) placebo-treated patien ts (P = 0.51), Clinical remission was achieved in three patients in ea ch group (16%). No toxicity was observed in either treatment arm, Conc lusions: The results suggests that once nightly 60 mt butyrate enemas (80 mmol/L) are not efficacious in the treatment of distal ulcerative colitis.