The Clinical Observation Of Mesalamine Suppository For The Treatment Of Ulcerative Colitis

The ulcerative colitis (UC) is a kind of chronic non-specificity inflammation existed in the rectum, under the colon mucous membrane and the mucous membrane.Now the cause of the UC is not clear.The pathological changes,with continuity and diffuse distribution ,generally begin with the anus end rectum upward expansion, may expand to the descending colon, the colon transversum, even may implicate the entire colon. The pathogenesis of this disease may be associated with immune, genetic, infectious and mental factors .Most of the disease happen slowly ,a small number of acute, occasional outbreaks of acute onset. The course is chronic and the onset usually alternates with remission. Clinically to the rectum, sigmoid colon often involved, the main symptoms are abdominal pain, diarrhea, hematochezia and mucus would like it, pain is generally mild to moderate to the left lower abdomen is found.The stool frequency and degree of hematochezia response the severity and activity of the disease , constipation occasionally. Colonoscopy is an important diagnostic tool in this disease, the disease with refractory and easy to relapse, and the characteristics of cancerous tendencies.The disease incidence in Western countries is as much as 10/10 ~ 15/10 million, the prevalence rate of more than 200/10 million. In Asia, the annual incidence is 1.0/10 ~ 2.0/10 million, the annual prevalence rate of 44.3/10 to 4.0/10 million. In recent years an increasing number of domestic has been reported, the incidence increases year by year.UC has become more common digestive diseases and a major cause of chronic diarrhea. Based on the characteristics of the disease and the incidence increased significantly in the clinical work, a reasonable choice of effective treatment for the rapid mitigation of the disease and improve the quality of life of patients is particularly important.The drug aminosalicylate sulfasalazine (SASP) is widely used in clinical , and it's a common treatment of the UC. The drug is useful for the light, medium, and the prevention of relapse in patients .Study found that the active site of the SASP is 5-ASA, if the direct oral 5-ASA, the majority of drugs is absorbed in the proximal small intestine, and the colon lesion has a very low concentration, it is difficult to achieve therapeutic purposes. Treatment effect based on local is fast as well as doesn't have to take many times ,so for mild to moderate patients localized treatment should be preferred. Gradually over the past few years the clinical application of 5-ASA suppositories, applied to lesions located in a remote area in patients with ulcerative colitis.Studies have shown that the treatment of distal rectal suppository is an effective form for UC, and more easily accepted by patients, the survey showed that the symptoms in most patients in complete remission within four weeks, if the treatment of patients only partial remission, you may continue to application of 4 ~ 6 weeks and still be able to complete remission.Objective:Observation of mesalazine enteric-coated tablets and suppositories mesalazine treatment of active mild to moderate ulcerative colitis compared the efficacy, providing a reliable basis for the choice of treatment for clinical programs.Method:Selected in our hospital from December 2006 to June 2008, out-patient and ward diagnosed with chronic active mild to moderate ulcerative colitis were 95 cases, treatment is divided into A group of oral mesalazine tablets (jiamusi Di Lu Hui Ling pharmaceutical); the treatment of anal application of group B mesalazine suppository (Heilongjiang Tianhong Pharmaceutical Co., Ltd.). The total course of treatment for eight weeks. 8 week and 6 months after the evaluation of patients with symptoms, signs, examination, colonoscopy and histopathological examination of the situation in order to observe the mesalamine suppository treatment.Results:Enteric-coated mesalazine tablets with mesalazine suppositories for the treatment of mild to moderate UC, there are no significant differences in efficiency (P> 0.05), but the suppository group significantly higher efficiency compared with the enteric-coated tablets there was a significant difference sex (P <0.05), note suppository for the treatment of distal UC than enteric-coated tablets; suppository group compared with the enteric-coated tablets, the complex signs and symptoms often are significant differences in the rate (P <0.05), note suppository for UC symptoms and signs better than the enteric-coated tablets mitigation; suppository group compared with the enteric-coated tablets, endoscopic lesions and histological remission rates have significant difference in remission rate (P <0.05), note suppository compared with the enteric-coated tablets the scope of the changes for the UC and the improvement of histological better; suppository group compared with the enteric-coated tablets, the incidence of adverse reactions decreased significantly (P <0.05), indicating that the treatment of UC, mesalazine suppository than enteric-coated tablets more security; suppository group compared with the enteric-coated tablets for the prevention of recurrence of UC no significant difference (P> 0.05)Discussion:Ulcerative Colitis (Ulcerative colitis, UC) is a cause not yet clear involvement of the rectum and colon of chronic non-specific inflammation. Previous studies that the incidence of genetic factors and immune-related, mental factors and infection is a predisposing factor, the new study considered a variety of inflammatory cells, inflammatory mediators, cytokines and nervous and the immune, endocrine interaction between the peptide, together of intestinal damage. At the same time, UC tissue damage was mainly due to inflammation caused by the expansion of the response, if any of them can prevent a part, may reduce or terminate the inflammatory injury.Drugs aminosalicylate sulfasalazine (SASP) is widely used in clinical treatment of ulcerative colitis, its mechanism may be able to colon-specific drug delivery, and contact inhibition of intestinal epithelial prostaglandin E, and various inflammatory leukotriene anti-inflammatory cells and play a role. The drug on the light, medium, and the prevention of recurrence of patients are effective in recent years developed a special 5-ASA agents so that they can play a pharmacodynamics reach the colon, such as the now commonly used in clinical mesalamine, olsalazine, a large number of clinical and practice has proved that in addition to mesalazine can inhibit prostaglandins, leukotrienes and inflammatory cells produce a variety of functions, it is strong and effective scavenger of oxygen free radicals, able to remove the OH and other free base, and another experimental study shows that abnormal regulation of the immune system in ulcerative colitis may be an important part of the pathogenesis, Amino big catkin willow acids medicine Liu Danhuang pyridine (SASP) can not be reduced mainly due to immune activation of pro-inflammatory cytokines increased, while peripheral blood was found in patients with UC and colon tissue of IL-6, IL-8 levels were significantly increased and improved with the decline in condition. Mesalazine inhibits NF2κB activity, thereby inhibiting gene transcription of TNF2αlevel of the production and release of TNF2αreduced because of reduced TNF2α, on the one hand, can reduce intestinal TNF2αcaused the injury, on the other hand, can reduce vascular endothelial small cell macrophages, neutrophils stimulated by the IL-6, IL-8. IL-6, IL-8 release and secretion can be reduced indirectly reduce the intestinal damage, and thus play a role in the treatment of UC. Mesalazine SASP with the same effect and at the same time, significantly reducing the incidence of adverse reactions and improve the safety of treatment A result of salicylic acid in the colon-specific drug release, so the scope of the lesion is located in the rectum, sigmoid colon of patients with poor oral drugs, clinical application of mesalazine or mesalazine combined with glucocorticoid treatment retention enema for ulcerative colitis the exact effect is to retain the enema treatment can make the direct effect of drugs on the lesion to minimize the occurrence of systemic side effects, and absorption of sound, even if the condition of patients at the same time oral hormones, can also reduce the amount of hormone to shorten the treatment course, but the traditional enema in the treatment of conditions of high, so that Enema of the clinical application of treatment is limited, agents and suppository enema development and listing, the lesions confined to the rectum, sigmoid colon of patients with a reduction of the adverse reactions of oral medication, as opposed to enema treatment facilitate easier to be accepted by patients, and treatment compliance in patients with a corresponding improvement.Studies have shown that the treatment of distal rectal suppository is an effective form UC, and more easily accepted by patients, 5 - aminosalicylic acid suppositories, anal with 1000mg, 1 times / day, at night before going to bed applications, the advantages will enable the 5 - amino - salicylic acid directly from the rectal mucosa absorption of lesion formation in high concentration. Survey of symptoms in most patients in complete remission within four weeks, four weeks if the treatment of patients with only partial remission, may continue the application of 4 to 6 weeks, still be able to complete remission. Rectal foam can be achieved within the anus about 15 ~ 20cm, it should be noted that when the insert medication may cause hardware damage control.in addition, if the condition seriously, broader changes may make use of the oral and local drug treatment, for example, enteric-coated tablets of mesalazine with mesalazine suppository treatment, enteric-coated mesalazine tablets with Glucocorticoid enema combination therapy, can alleviate the greater the patient's symptoms and signs. 5-ASA suppositories applied to lesions in the rectum as well as the treatment of active ulcerative colitis, colitis in the last paragraph of the results would be a better drug to reach the rectum, sigmoid colon region (10cm within the scope of the anus), at the same time unique to wax suppository vector approach can improve the stability of drugs in the rectum, sigmoid colon to maintain a higher concentration of the drug all play a direct role, through the intestinal mucosa (colon, rectum) slow, continuous release of 5 - aminosalicylic acid, to anti-inflammatory effects, reducing due to intestinal pH, gastric emptying rate, bacteria and diarrhea factors, and the effect of more than oral preparationsConclusion: Mesalazine suppositories in active stage of chronic mild to moderate distal ulcerative colitis a better effect, in particular mesalazine suppository few adverse reactions, but the treatment suppository has some shortcomings, first, suppository compared with the intestinal film in terms of melting, which is very expensive, relatively heavy financial burden on patients; Secondly, a wider scope for the disease, but also the scope of or located in high disease patients, treatment effectiveness is still not observed in this regard can not be clear for the suppository treatment of such patients effectively; Third, for the heavy and the outbreak of ulcerative colitis and application type of glucocorticoid treatment of recurrent ulcerative colitis, suppository treatment is unclear. For these reasons limit the clinical application of suppositories. Data show that oral and suppository combination than alone has better efficacy, a study found, oral and rectal 5-ASA with the patient, l2 months to maintain the remission rate (61%) was significantly better than oral 5 -ASA group (31%, P = 0.04). Therefore, a wider scope for the disease, patients with severe disease, combination therapy can be considered.