GASTROENTEROLOGY ARTICLE OF THE WEEK

February 1, 2001

 1.  The preferred initial therapy for a patient with ulcerative colitis extending to 40 cm from the anal verge is:

            a.  oral corticosteroids

            b.  rectal steroids

            c   oral ASA preparation

            d.  rectal ASA preparation

 True or False

 2.  ASA preparations exert their beneficial effect in the colon after being absorbed systemically and secreted in the colon and small intestine lumen.

 3.  Suppositories deliver medications only to the rectum, foam deliver medication up to the proximal sigmoid colon, and liquid enemas may reach the splenic flexure.

 4.  The higher the dose of 5-ASA delivered by enema the better the clinical response

 5.  Corticosteroids enemas are more effective than 5-ASA enemas.

 6.  ASA absorption after rectal administration is highest in patients with active colitis

 7.  Maintenance therapy with ASA enemas requires daily administration

 8.  Which of the following is (are) the therapy of choice for a patient with active proctitis (up to 5 cm from anal verge)

            a.  oral corticosteroids

            b.  steroid enemas

            c.  ASA suppositories

            d.  rectal foam

            e.  oral ASA preparation

 9.  A patient with clearly defined proctosigmoiditis (up to 35 cm of disease) fails to respond to daily ASA enemas.  Repeat sigmoidoscopy confirms extent of disease to only 35 cm.  Recommended approaches include

            a.  use two instead of one ASA enema at a time

            b.  combine oral ASA with rectal ASA

            c.  use rectal steroid and rectal ASA combination therapy (alternate enemas)

            d.  start 60 mg of prednisone orally

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