Maintaining Remission in Distal Ulcerative Colitis and Ulcerative Proctitis

Maintenance of remission is an important consideration in themedical care of patients with ulcerative colitis. The relapse rate is high whenmedications are discontinued. Many types of medications have been investigatedfor potential efficacy of maintaining remission. This paper reviews the literatureon maintenance therapy for both distal and universal ulcerative colitis. Sulphasalazineis the drug of choice since il is effective and relatively low m cost.5-aminosalicylic acid (5-ASA) derivatives, both oral and rectal forms, are alsoeffective. Other medications such as metronidazole, cromolyn sodium and prednisonehave nor been shown to be effective maintenance therapy. Strategies formaintenance are outlined and include possible regimens with 5-ASA enemas.While 1 g of 5-ASA is effective, the long term relapse rate is similar co that seenwith sulphasalazine. Patients capered co 1 g 5-ASA enemas have a good chanceof maintaining remission if the colitis does not flare within the first few months,because most colites will flare up early on. Other possible regimens includeintermittent enemas, eg, every other night or every third night. Patients inremission can be safely maintained in remission with sulphasalazine or one of its5-ASA derivatives