The availability of new topical preparations for the treatment of left sided
ulcerative colitis offers a
therapy optimization for many patients. Rectal application of
steroids and
5-aminosalicylic acid (5-ASA) is associated with fewer side effects and has a higher therapeutic efficacy in left-sided
colitis as compared to a systemic
therapy. Therefore, we were interested in the use of topical
therapy in patients with
ulcerative colitis. The key question was whether topical treatment is more frequently used than oral
therapy in patients with
proctitis and left sided
colitis. Data of 800 patients of the Swiss IBD cohort study were analyzed. Sixteen percent of patients of the cohort had
proctitis, 21%
proctosigmoiditis and 41% pancolitis. Topical
therapy with 5-ASA or
corticosteroids was given in 26% of patients with
proctitis, a combined systemic and topical treatment was given in 13%, whereas systemic treatment with 5-ASA without topical treatment was given in 29%. Proportion of topical
drug use decreased with respect to disease extension from 39% for
proctitis to 13.1% for pancolitis (P=0.001). Patients with severe
colitis received a significantly higher dose of topical 5-ASA than patients in remission. Side effects of topical or systemic 5-ASA or
budesonide treatment were less frequently seen compared to other medications. Topical treatment was frequently stopped over time. The quality of life was the same in patients with limited disease compared to patients with pancolitis. Topical treatment in
proctitis patients was underused in Switzerland. Since topical treatment is safe and effective it should be used to a larger extend.