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Suppositories better than foams/enemas for rectal symptoms in colitis?

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Ulcerative Colitis
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Posted 9/23/2018 3:54 PM (GMT -5)
An opinion shared at the Great Lakes IBD conference:

/twitter.com/guthealthmd/status/1043492913920061441
Posted 9/24/2018 12:36 PM (GMT -5)
What are your thoughts?

q
Posted 9/24/2018 1:04 PM (GMT -5)
Certainly raises more questions then answers to me. I'd want to know how a lower dosage and less of an area covered can be more effective? Maybe there is better absorption/delivery... dunno....
Posted 9/24/2018 2:24 PM (GMT -5)
My GI is one of the top IBD guys in Western Canada and says the suppository is better for rectal inflammation. He says that is directed to the area of most need. I just prefer the enema.
Posted 9/24/2018 9:24 PM (GMT -5)
Quincy, I had a couple thoughts:
1) Are supps perhaps showing more promise because compliance is easier? We all know enemas and foams can be anywhere from uncomfortable to outright painful when very inflamed so perhaps the difference is simply patient tolerance and therefore compliance? Similarly, it is generally easy to retain a supp compared to an enema (again, in a full flare) - i.e. the "something is better than nothing" argument... More benefit from holding a supp for 8-10 hours vs holding an enema/foam for 15 minutes.
2) My personal experience is that supps got me to a place where I could actually hold enemas so there is something to that aspect, at least.
3) For proctitis, I'd think a thicker, targeted treatment is better than a diluted liquid spreading out over an area where there is no disease. However, we know that there is a benefit to treating above the line of inflammation to prevent spread, so enemas would likely still play a role somehow.
Posted 9/25/2018 12:03 AM (GMT -5)
My opinion....and it's nigh 30 years worth....supps could gain support with compliance, but aren't in the same ballpark regarding dosage or coverage. They are an adjunct in combo with enemas and good for low in rectum / extremely limited inflammation. As well, it's been suggest many times to help lessen inflammation (during the day) so that enemas can be eased into retention.

They can be used during tapering... and if tapering is done properly, then use them for maintenance if the UCer understands early symptoms and step up accordingly.
They can also be used up to 3x daily, but financially....that would likely be a no-go.

Enemas come in various dosages, and can be concentrated to cover the entire rectum. Most taper the enemas too quickly....and don't understand the healing symptoms, because they aren't like the hell ones previous before starting them.

There have been enough here who have done only the supps and their UC has spread upward.....and many have been prescribed supps without oral mesalamine . And you mention not enough coverage....the sigmoid is a touchy areaas well, some are diagnosed with limited UP....via sig-scope....not seeing cecal involvement. No amount of rectal meds will be enough if the cecum isn't treated as well.

Superior to enemas? Never.....and i base it on experience. I don't need a study to contradict faithful commitment.
But, they have their place....definitely.

You choose what's best for you....i would suggest both in your regimen.

q
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