Novel therapies for Crohn disease and colitis
CMAJ 1997;156:634
I have several comments about the recent review by Dr. Donald S. Daly of my book Crohn's Disease and Ulcerative Colitis (CMAJ 1996;155:1452-3 [full text]).
First, the novel therapies with lidocaine (Xylocaine) and short-chain fatty acids are, in fact, readily available to patients. Lidocaine (in a 2% gel) has been on the market for many years; 30-mL tubes can be purchased over the counter in most pharmacies. At Sunnybrook Health Science Centre, our pharmacy sells the patients a 35-mL catheter-tip syringe for self-administration of lidocaine. Further information on this treatment, which is recommended mainly for patients with intractable distal ulcerative colitis, can be obtained from the literature.[1]
The first article concerning the use of short-chain fatty acids to treat colonic inflammation was published in 1989.[2] There have been 2 trials of enema therapy with these acids for ulcerative colitis.[3,4] The articles give the "recipe" for the enemas, which are easily manufactured by hospital pharmacies.
My final comment is about the target audience for this book. When I was invited to write the book, the goal was to create a user-friendly, comprehensive text for patients and their families. Reviews to date indicate that this objective was achieved. However, colleagues have pointed out to me that the book is also very useful for medical students, house staff, family practitioners, general internists and other health care professionals.
Fred Saibil, MD
Head
Division of Gastroenterology
Sunnybrook Health Science Centre
Associate Professor of Medicine
University of Toronto
Toronto, Ont.
References
- Bjorck S, Dahlstrom A, Johansson L, Ahlman H. Treatment of the mucosa with local anaesthetics in ulcerative colitis. Agents Actions 1992:C60-72.
- Harig JM, Soergel KH, Komorowski RA, Wood CM. Treatment of diversion colitis with short-chain-fatty acid irrigation.
N Engl J Med 1989;320:23-8.
- Steinhart AH, Brzezinski A, Baker JP. Treatment of refractory ulcerative proctosigmoiditis with butyrate enemas. Am J Gastroenterol 1994;89:179-83.
- Patz J, Jacobsohn WZ, Gottschalk-Sabag S, Zeides S, Braverman DZ. Treatment of refractory distal ulcerative colitis with short chain fatty acid enemas. Am J Gastroenterol 1996;91:731-4.
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