Experience with Short and Long Term Courses of Local Adrenal Steroid Therapy For Ulcerative Colitis

Abstract

Summary The advantages of rectal steroid therapy in ulcerative colitis are the rapidity of clinical response and the lack of troublesome complications encountered in systemic steroid therapy. The disadvantages of such therapy include expense, inconvenience, pathologic progression in some cases in spite of therapy, and the general lack of recognition that part of some of these compounds is absorbed in some patients. Those patients responding best to this mode of therapy have involvement only of the left colon demonstrable by x-ray and mucosal changes of mild to moderate activity seen proctoscopically. However, over half of the patients with involvement of the entire colon involved achieve a favorable response; therefore, such patients need not be excluded from this type of treatment. Chronic mucosal changes and long duration of disease seem to have no effect upon the prospects for a good response. The incidence of favorable response seemed similar in all preparations used; however, the concurrent appearance of fluid retention and acne is associated with hydrocortisone hemisuccinate and prednisolone sodium succinate. The results of the present method of administering local steroid enemas compare favorably with those of others. Long term use of steroid enemas reduces the incidence of relapse partially, but has no appreciable advantage over short term therapy as demonstrated by long term follow up. Complete remissions of ulcerative colitis are accomplished and sustained less frequently with the use of adrenal steroid enemas than with systemic steroid therapy.