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Comparative study of enema retention and preference in ulcerative colitis

¹ Department of Gastroenterology, Cardiff and Vale NHS Trust, Cardiff, UK
² St Mary’s Pharmaceutical Unit, Llanishen, Cardiff, UK
³ Department of Epidemiology, Statistics and Public Health, Cardiff University, Cardiff, UK

Correspondence to:
Correspondence to:
Dr G A O Thomas
Department of Gastroenterology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK; Gareth.Thomas2{at}UHW-TR.wales.nhs.uk

Background: Therapeutic enemas are often used to treat active colitis but their retention may be limited because of urgency to defecate. Some preparations may be better retained and tolerated than others because of their physical properties.

Aim: To compare patient preference and retention of four therapeutic enemas, including a nicotine enema, in patients with ulcerative colitis (UC).

Methods: Twenty four patients with active UC received the four trial enemas—corticosteroid, 5-amino salicylate (5-ASA), and nicotine liquid enemas and a corticosteroid foam, in a randomised order, taking one enema on each of four successive nights. Patients scored them 1 to 4 for ease of administration and retention, degree of abdominal bloating, and for their overall preference.

Results: Fifteen patients rated nicotine their overall favourite or second favourite, compared with 14 for corticosteroid foam and 11 for 5-ASA and corticosteroid liquids, but this was not significant (p = 0.302). Overall, there was no significant difference in overnight retention. However, the nicotine enema tended to be less well retained in patients with milder urgency but a higher proportion retained it overnight with more severe urgency (p = 0.031 compared with 5-ASA enema).

Conclusion: There was no significant difference in patient preference or overall duration of retention for the four enemas.

Abbreviations: UC, ulcerative colitis; AE, adverse event; UCDAI, ulcerative colitis disease activity index; 5-ASA, 5-amino salicylate

Keywords: ulcerative colitis; enema retention; nicotine enema