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World J Gastrointest Pharmacol Ther. Oct 6, 2010; 1(5): 87-93
Published online Oct 6, 2010. doi: 10.4292/wjgpt.v1.i5.87
Novel topical therapies for distal colitis
Ian Craig Lawrance
Ian Craig Lawrance, Centre for Inflammatory Bowel Diseases, Department of Gastroenterology, Fremantle Hospital, Fremantle, 6059, WA, Australia; University Department of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, 6059, WA, Australia
Author contributions: Lawrance IC solely contributed to this paper.
Correspondence to: Ian Craig Lawrance, Professor, University Department of Medicine and Pharmacology, University of Western Australia, Level 5 T Block, Fremantle Hospital, Alma Street, Fremantle, 6059, WA, Australia. ian.lawrance@uwa.edu.au
Telephone: +61-8-94316347 Fax: +61-8-94313160
Received: April 13, 2010
Revised: September 21, 2010
Accepted: September 28, 2010
Published online: October 6, 2010

Distal colitis (DC) can be effectively treated with topical 5ASA agents. Suppositories target the rectum while enemas can reliably reach the splenic flexure. Used in combination with oral 5ASAs, the control of the inflammation is even more effective. Unfortunately, resistant DC does occur and can be extremely challenging to manage. In these patients, the use of steroids, immunosuppressants and the anti-tumor necrosis factor α agents are often required. These, however, can be associated with systemic side effects and are not always effective. The investigation of new topical therapeutic agents is thus required as they are rarely associated with significant blood drug levels and side effects are infrequent. Some of the agents that have been proposed for use in resistant distal colitis include butyrate, cyclosporine and nicotine enemas as well as tacrolimus suppositories and tacrolimus, ecabet sodium, arsenic, lidocaine, rebamipide and Ridogrel® enemas. Some of these agents have demonstrated impressive results but the majority of the agents have only been assessed in small open-labelled patient cohorts. Further work is thus required with the investigation of promising agents in the context of randomized double-blinded placebo controlled trials. This review aims to highlight those potentially effective therapies in the management of resistant distal colitis and to promote interest in furthering their investigation.

Keywords: Resistant proctitis, Tacrolimus, Treatment, Topical