Nicotine Enemas Don't Help Ulcerative Colitis

New study shows no improvement in symptoms compared with placebo

WEDNESDAY, Nov. 2, 2005 (HealthDay News) -- Although one recent study touted the benefits of nicotine enemas for treating ulcerative colitis, a new British trial finds no therapeutic effect from this unusual treatment.

According to the results of this latest study, the enemas were well-tolerated but offered no improvement in symptoms for people with active ulcerative colitis. The report appears in the November issue of Clinical Gastroenterology and Hepatology.

In the study, led by Dr. John R. Ingram from the Department of Gastroenterology at Cardiff and Vale National Health Services Trust, the research team gave 104 patients who had active ulcerative colitis 6-milligram nicotine enemas or a placebo daily for six weeks. During the trial, patients who were taking other medications for ulcerative colitis kept taking them.

The researchers found that 14 of the 52 patients who received the nicotine enemas achieved remission of their ulcerative colitis, compared with 14 of the 43 patients who received placebo enemas. All of the patients continued using any oral therapy previously prescribed.

"There was no significant difference between the clinical benefit of 6-milligram nicotine enemas and placebo," the researchers concluded. "The nicotine enemas were well-tolerated and only one patient withdrew because of an adverse event."

However, one expert thinks this study isn't the last word on the use of nicotine for treating ulcerative colitis, especially since studies have noted that smoking can actually ameliorate ulcerative colitis symptoms.

"The effects of smoking in inflammatory bowel disease is one of the most interesting epidemiologic observations in these patients, since smoking is beneficial for patients with ulcerative colitis and detrimental for patients with Crohn's disease," noted Dr. Fabio Cominelli, a professor of medicine and head of the Division of Gastroenterology at the University of Florence, Italy, and director of the Digestive Health Center at the University of Virginia Health System.

"Quitting smoking is actually one of the most important risk factors for developing ulcerative colitis," he added. Experts still stress, however, that the bad effects of smoking -- most notably the high risk for cancer -- mean quitting is always a smoker's best bet.

Cominelli also noted that the delivery of nicotine enemas does not guarantee that the active compound reaches the target cells within the intestine's mucosal lining.

"It is conceivable that the effects of nicotine in ulcerative colitis requires systemic administration, and may affect also cells and tissues in other parts of the body that in turn affect symptoms of colitis, similar to the systemic effects of smoking a cigarette," Cominelli said.

Another expert believes that patients with ulcerative colitis should look for treatment with newer drugs and not rely on conventional treatments.

"This study confirms that nicotine enemas are relatively safe, but there isn't evidence that they provide clinical benefit," said Dr. Jonathan Braun, chairman of the department of pathology at UCLA's David Geffen School of Medicine.

The problem is that ulcerative colitis has been resistant to some of the new drugs, Braun said. "There is a real need to find innovative ways to provide more therapeutic options for patients with this disease," he said.

The results of this study don't encourage the testing of nicotine enemas again, Braun said. "The findings suggest that there is not a pharmacologic advantage to using enemas compared to patches," he noted.

Even though a patch delivers more nicotine than an enema, Braun doesn't believe nicotine has much benefit in treating ulcerative colitis.

Braun explained that enemas have few adverse effects because they only deliver a small amount of the drug into the bloodstream. "It suggests to me that an enema is not an advantageous way to deliver drugs."

Patients who have ulcerative colitis should "not look to the use of conventional therapies," Braun said. "They should look to emerging biologicals such as infliximab and the anti-integrins, which are still experimental."

More information

For more on ulcerative colitis, head to the National Digestive Diseases Information Clearinghouse.

SOURCES: Jonathan Braun, M.D., Ph.D., professor and chairman, department of pathology, David Geffen School of Medicine, UCLA; Fabio Cominelli, M.D., Ph.D., professor, medicine, and head, Division of Gastroenterology, University of Florence, Italy, and director, Digestive Health Center, University of Virginia Health System, Charlottesville; November 2005 Clinical Gastroenterology and Hepatology
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