Rectal irrigation with short-chain fatty acids for distal ulcerative colitis. Preliminary report

Colon cells from patients with ulcerative colitis utilize short-chain fatty acids inefficiently and may be exposed to decreased concentrations of these compounds. To test whether irrigation of the inflamed mucosa with short-chain fatty acids is useful, we conducted a six-week preliminary trial in 12 patients with distal colitis. Each patient used twice daily rectal irrigations with 100 ml of a solution containing acetate (80 mM), propionate (30 mM), and butyrate (40 mM). Two patients stopped at three weeks, one because of no improvement and the other because of complete resolution of symptoms. Of the 10 who completed the trial, nine were judged to be at least much improved and showed a change in a mean disease activity index score from 7.9 +/- 0.3 (SE) to 1.8 +/- 0.6 (SE) (P less than or equal to 0.002) and in a mucosal histology score from 7.7 +/- 0.7 (SE) to 2.6 +/- 0.7 (SE) (P less than or equal to 0.002). Thus, ulcerative colitis patients appear to benefit from increased contact with or higher than usual levels of these critical energy substrates.

Percutaneous-endoscopic biliary stent placement: a clinician's perspective

When it becomes necessary to relieve obstructive biliary jaundice, many alternatives are entertained by the physician, the patient and the family. This article describes percutaneous-endoscopic biliary stent placement from this gastrointestinal clinician's point of view, taking into account the previously utilized efforts of surgery, radiology and endoscopy. It will serve as a reference for all those who choose our method when the need to relieve biliary obstruction is encountered.