Hydrocortisone ulcerative colitis

Glucocorticoid therapy is indicated in selected patients with inflammatory bowel disease, chronic ulcerative colitis as well as Crohn s disease. Agents include prednisolone, hydrocortisone and budes-onide, the latter having a predominantly local effect... 

Local therapy, such as topical preparations for skin disease, ophthalmic forms for eye disease, intra-articular injections for joint disease, inhaled steroids for asthma, and hydrocortisone enemas for ulcerative colitis, provides a means of delivering large amounts of steroid to the diseased tissue with reduced systemic effects. 

Acute pancreatitis after rechallenge provides direct evidence that hydrocortisone can cause acute pancreatitis in a patient with ulcerative colitis (162). 

Khanna S, Kumar A. Acute pancreatitis due to hydrocortisone in a patient with ulcerative colitis. J Gastroenterol Hepatol 2003 18 1010-1. 

Topical preparations of mesalamine suspended in a wax matrix suppository (rowasa) or in a suspension enema (canasa) are effective in active proctitis and distal ulcerative colitis, respectively. They appear to be superior to topical hydrocortisone in this setting, with response rates of 75-90%. Mesalamine enemas (4 g/60 mL) should be used at bedtime and retained for at least 8 hours the suppository (500 mg) should be used two to three times a day with the objective of retaining it for at least 3 hours. Response to local therapy with mesalamine may occur within 3-21 days however, the usual course of therapy is from 3-6 weeks. Once remission has occurred, lower doses are used for maintenance. 

Hydrocortisone is used (i) orally for replacement therapy (ii) imra-venousiy in shock and status asihmaiieus and (lit) topicaJly (e.g. ointments in eczema, enema.s in ulcerative colitis). 

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