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Canadian Journal of Gastroenterology
Volume 16, Issue 5, Pages 293-296
Original Article

Distal Ulcerative Colitis Refractory to Rectal Mesalamine: Role of Transdermal Nicotine versus Oral Mesalamine

Mario Guslandi, Roberto Frego, Edi Viale, and Pier Alberto Testoni

Gastroenterology Unit, San Raffaele University Hospital, Milan, Italy

Received 4 December 2001; Accepted 13 March 2002

Copyright © 2002 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


BACKGROUND: Distal ulcerative colitis usually responds to treatment with rectal mesalamine, but the management of refractory cases is poorly defined.

AIM: To evaluate the possible therapeutic benefit of transdermal nicotine versus oral mesalamine.

PATIENTS AND METHODS: Thirty patients with left-sided ulcerative colitis unresponsive to treatment with a mesalamine 4 g enema at bedtime were randomly allocated to additional therapy with either transdermal nicotine 15 mg daily or oral mesalamine 800 mg tid for four weeks. Clinical remission was evaluated by Rachmilewitz’s activity index and confirmed by sigmoidoscopy.

RESULTS: Remission was observed in 12 of 15 patients receiving additional treatment with nicotine and in five of 15 patients receiving additional treatment with oral mesalamine (P=0.027).

CONCLUSIONS: The addition of transdermal nicotine to treatment with mesalamine enemas is significantly superior to combined therapy with oral and rectal mesalamine in patients with distal ulcerative colitis refractory to rectal mesalamine alone.