Prednisolone 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... 

Mrs D has recently been admitted with an episode of acute severe ulcerative colitis. This is her third flare this year. This time she has a 5-day history of bloody diarrhoea with abdominal pain. On average she is opening her bowels seven times a day. She is currently taking mesalazine 800 mg three times daily and prednisolone 20 mg daily. Mrs D also has an elevated temperature of 38°C and a pulse rate of 92 bpm. She is due to have an abdominal X-ray and a stool culture. 

Although systemic absorption of the prednisolone from the enema probably does occur, especially when the colon is particularly inflamed, corticosteroids usually have less systemic effects when given this way. Furthermore, by giving an enema, the drug is being delivered directly to its site of action - remember that in ulcerative colitis the disease is confined to the lower gastrointestinal tract. 

Thomas P, Richards D, Richards A. Absorption of delayed release prednisolone in ulcerative colitis and Crohn s disease. J Pharm Pharmacol 1985 37 757-758. 

A 38-year-old man with ulcerative colitis who had taken mesalazine for many years was switched to balsalazide 2.25 g tds and prednisolone 15 mg/day. However, 14 days later, while his bowel symptoms were improving, he developed intermittent chest pain (not typical of ischemia or pericarditis). Cardiac troponin I and C reactive protein were raised and there was widespread T wave inversion. Echocardiography showed apical and posterior segment wall motion abnormality with no effusion. A diagnosis of myocarditis was made, and balsalazide was withdrawn. His cardiac symptoms resolved within 48 hours. 

Plasma prednisolone levels comparable to those obtained after peroral administration were observed after prednisolone-21-phosphate retention enema in ulcerative colitis (115 ). Eight cases with appearance of uterine bleeding in relation to initiation of steroid therapy have been reported (10 ). 

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