Randomized comparison of unfractionated heparin with corticosteroids in severe active inflammatory bowel disease

Background: Heparin therapy may be effective in steroid resistant inflammat ory bowel disease. Aim: A randomized pilot study, to compare unfractionated heparin as a first -line therapy with corticosteroids in colonic inflammatory bowel disease. Methods: Twenty patients with severe inflammatory bowel disease (ulcerative colitis, n = 17; Crohn's colitis, n = 3) were randomized to either intrave nous heparin for 5 days, followed by subcutaneous heparin for 5 weeks (n = 8), or high-dose intravenous hydrocortisone for 5 days followed by oral pre dnisolone 40 mg daily, reducing by 5 mg per day each week (n = 12). After 5 days, non-responders in each treatment group were commenced on combination therapy. Response to therapy was monitored by: clinical disease activity ( ulcerative colitis: Truelove and Witt Index; Crohn's colitis: Harvey and Br adshaw Index), stool frequency, serum C-reactive protein and al acid glycop rotein, endoscopic and histopathological grading. Results: The response rates were similar in both treatment groups: clinical activity index (heparin vs, steroid; 75% vs, 57%; P = 0.23), stool frequen cy (75% vs. 67%; P = 0.61), endoscopic (75% vs, 67%; P = 0.4) and histopath ological grading (63% vs. 50%; P = 0.67). Both treatments were well-tolerat ed with no serious adverse events. Conclusion: Heparin as a first line therapy is as effective as corticostero ids in the treatment of colonic inflammatory bowel disease. Large multicent re randomized comparative studies are required to determine the role of hep arin in the management of inflammatory bowel disease.