Patients with ulcerative colitis uniformly have disease involving the distal colon. When patients have disease
limited to the left colon or symptoms suggestive of active rectal inflammation, guidelines recommend topical rectal therapies
as first-line agents either as monotherapy or in conjunction with oral products. Rectal delivery modalities offer the
advantage of delivering high local concentrations of active medication to the site of maximal inflammation with minimization
of systemic side effects. Methods of rectal administration include suppositories, liquid enemas and foams. Suppositories
are limited to the treatment of rectal disease, and patients often have difficulty retaining the liquid enema secondary
to its high volume and consistency. Rectal foams reliability extend to the descending and sigmoid colon with application.
Foams are further characterized by increased viscosity, lower volumes, finer dispersion on the colonic mucosa, and increased
adhesiveness to the colonic mucosa compared with liquid enemas. Additionally, rectal foam agents demonstrate
equal efficacy to their liquid enema counterparts yet consistently yield better patient tolerance, lower incidence of side effects,
and increased patient acceptability. Currently available agents include 5-aminosalicylic acid and corticosteroids,
both first and newer generation. This review focuses on clinical trials assessing efficacy, tolerability, and patient preferences
for these agents as well as describing the currently available rectal foam products.
Keywords: Ulcerative colitis, proctitis, enemas, foam preparations, 5-aminosalicylic acid, corticosteroids, systematic review
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