Most modern steroid enemas are foam based - as the likelihood of someone with colitis being able to retain a water based enema is quite low. These act topically applying the steroid directly to the colon - with only small amounts being absorbed into the bloodstream. This makes side effects less likely. The downside is that they can only reach the descending colon and rectum - so for those with extensive colitis oral steroids may be needed. A combination of Entocort and steroid enemas can provide topical treatment to the majority of the colon - again minimizing side effects. As the two main steroid enemas differ quite greatly I will cover them separately.
Patients should be instructed to shake the bottle well to make sure the suspension is homogeneous. The patient should remove the protective sheath from the applicator tip. Holding the bottle at the neck will not cause any of the medication to be discharged. The position most often used is obtained by lying on the left side (to facilitate migration into the sigmoid colon); with the lower leg extended and the upper right leg flexed forward for balance. An alternative is the knee-chest position. The applicator tip should be gently inserted in the rectum pointing toward the umbilicus. A steady squeezing of the bottle will discharge most of the preparation. The preparation should be taken at bedtime with the objective of retaining it all night. Patient instructions are included with every seven units.
A 4-week single-blind, randomized, reference-controlled, parallel-group study compared the clinical efficacy and safety of glucocorticosteroid enemas in 47 children with ulcerative colitis. 23 children (range 7-15 years) were randomized and treated with Entocort Enema and 24 children (range 6 -15 years) with Pred-Clysma enema. The primary efficacy variable was remission, defined by endoscopic improvement and absence of clinical symptoms of ulcerative colitis. The remission rate after 4 weeks was 50% in the Entocort group and 71% in the Pred-Clysma group. The difference was not statistically significant. The primary safety variable was adrenal suppression, defined by changes in plasma cortisol levels after ACTH-stimulation. There was a statistically significant difference in the percentage of patients with normal adrenal function at week 4 (Entocort 73%, Pred-Clysma 33%). (Study LD-008-0003).