A PRACTICAL GUIDE TO THE MANAGEMENT OF DISTAL ULCERATIVE-COLITIS

This article reviews the role of corticosteroids. sulfasalazine and me salazine (5-aminosalicylic acid, mesalamine). immunosuppressive agents and alternative novel drugs for the treatment of distal ulcerative co litis. Short cycles of traditional. rectally administered corticostero ids (methylprednisolone, betamethasone, hydrocortisone) are effective for the treatment of mild to moderately active distal ulcerative colit is. In this context, their systemic administration is limited to patie nts who are refractory to either oral 5-amino-salicyclates. topical me salazine or topical corticosteroids. OF no value in maintaining remiss ion, the long term use of tither or topical corticosteroids may be haz ardous. A nerv class of topically acting corticosteroids [budesonide, fluticasone, beclomethasone dipropionate, prednisolone-21-methasulphob enzoate, tixocortol (tixocortol pivalate)] represents a valid alternat ive for the treatment of active ulcerative colitis, and may be useful in the treatment of refractory distal ulcerative colitis. Although the re is controversy concerning dosage or duration of therapy, oral and t opical mesalazine is effective in the treatment of mild to moderately active distal ulcerative colitis. Sulfasalazine and mesalazine remain the first-choice drugs far the maintenance therapy of distal ulcerativ e colitis. Evidence exists showing a trend Co a higher remission rate with higher doses uf oral mesalazine. Topical mesalazine (suppositorie s or enemas) also is effective ill maintenance treatment. For patients with chronically active or corticosteroid-dependent disease, azathiop rine and mercaptopurine are effective in reducing either the need for corticosteroids or clinical relapses. Moreover, they are effective For long term maintenance remission. Cyclosporin may bit useful in induci ng remission in patients with acutely severe disease who do not achiev e remission with im intensive intravenous regimen. Existing data sugge st that azathioprine and mercaptopurine may be effective in prolonging remission in these patients. The role of alternative drugs for the tr eatment of distal ulcerative colitis and its different forms is review ed. in particular data are reported concerning the effectiveness of 5- lipoxygenase inhibitors, topical use of short chain Catty acids, nicot ine, local anaesthetics, bismuth subsalicylate enema, sucralfate, clon idine, free radical sc avengers, heparin and hydroxychloroquine.