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The knowledge that 5-aminosalicylic acid (5-ASA) is the active compound of sulphasalazine and that it acts topically has stimulated the use of 5-ASA containing enemas and ocher similar compounds such as olsalazine and 4-aminosalicylic acid (4-ASA). 5-ASA enemas have been shown to be effective in controlling active disease in clinical trials and have also been shown to be of benefit in prevention of relapses. Olsalazine enemas have not demonstrated significantly better results than placebo 4-ASA enemas are effective but the results obtained have differed as to effective dose

5-Aminosalicylic acid (5-ASA) enemas constitute a first-line therapy for patients with mild to moderate attacks of ulcerative colitis. To date, based on the results of different studies, 5-ASA enemas appear to be satisfactory in at least two-thirds of patients treated. Beclomethasone is one of the new corticosteroids which appear to have minimal systemic effects. The authors have assessed the efficacy of a four week course of 3 mg beclomethasone enemas compared to 2 g 5-ASA enemas in patients with ulcerative colitis. Preliminary analysis would suggest that both therapies are effective in more than 50% of cases.

Forty patients with active hemorrhoidal disease were entered into this double-blind trial, 20 of whom were randomized to treatment with 5-aminosalicylic acid (5-ASA) (500 mg) suppositories. Clinical and sigmoidoscopic assessment was carried out before the start of the trial and after two weeks of treatment. At the end of the study, 5-ASA suppositories showed results superior to those of placebo for all parameters evaluated (P

Barium enema and colonoscopy are contraindicated in severe attacks of ulcerative colitis because of the possibility of toxic megacolon and perforation. The authors have assessed abdominal ultrasound in 38 patients with severe ulcerative colitis. Ultrasound revealed bowel wall thicknesses ranging from 3.9 to 9.2 mm (mean 7.7) extending the whole length of the colon, to the transverse colon, and to the descending colon, respectively, in 18, 10 and eight patients. The degree of bowel thickening was related to the severity of inflammation based on clinical, sigmoidoscopic and histological evaluation. In two patients, ultrasound showed a thin bowel wall distended without motility, suggesting the diagnosis of toxic megacolon (confirmed radiologically). An excellent correlation (95%) was found between ultrasound and technetium-99 scanning. Ultrasound might be a reasonable first investigation in the assessment of patients with severe ulcerative colitis.