SHORT-CHAIN FATTY-ACID RECTAL IRRIGATION FOR LEFT-SIDED ULCERATIVE-COLITIS - A RANDOMIZED, PLACEBO-CONTROLLED TRIAL

Background-Short chain fatty acid (SCFA) deficiency is associated with colitis in animals and humans, and the mucosal metabolism of these co mpounds is decreased in ulcerative colitis. Aims-To assess the efficac y of topical SCFA treatment in ulcerative colitis. Patients and Method s-103 patients with distal ulcerative colitis were entered into a six week, double-blind, placebo controlled trial of rectal SCFA twice dail y; patients who were unchanged on placebo were offered SCFA in an open -label extension trial. Results-Of the 91 patients completing the tria l, more patients in the SCFA treated than in the placebo treated group improved (33% v 20%, p=0.14, NS). Those on SCFA also had larger, but statistically non-significant, reductions in every component of their clinical and histological activity scores. In patients with a relative ly short current episode of colitis (<6 months, n=42), more responded to SCFA than to placebo (48% v 18%, p=0.03). These patients also had l arger, but statistically non-significant, decreases in their clinical activity index (p=0.08 v placebo). Every patient who improved used at least five of six of the prescribed rectal SCFA irrigations, whereas o nly 37% who did not improve were as compliant. In the open-label exten sion trial, 65% improved on SCFA; these patients also had significant reductions (p<0.02) in their clinical and histological activity scores . Conclusions-Although SCFA enemas were not of therapeutic value in th is controlled trial, the results suggest efficacy in subsets of patien ts with distal ulcerative colitis including those with short active ep isodes. Prolonged contact with rectal mucosa seems to be necessary for therapeutic benefit.