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. 2000 Sep;47(3):410–414. doi: 10.1136/gut.47.3.410

Mucosal 5-aminosalicylic acid concentration inversely correlates with severity of colonic inflammation in patients with ulcerative colitis

G Frieri 1, R Giacomelli 1, M Pimpo 1, G Palumbo 1, A Passacantando 1, G Pantaleoni 1, R Caprilli 1
PMCID: PMC1728031  PMID: 10940280

Abstract

BACKGROUND AND AIM—The treatment of ulcerative colitis (UC) with 5-aminosalicylic acid (5-ASA) does not have the same therapeutic effect in all patients. We tested the hypothesis that the effectiveness of the drug is related to its mucosal concentration.
PATIENTS—Twenty one UC patients receiving oral 5-ASA (2.4-3.2 g/day) were enrolled in the study. Four were also receiving topical treatment (2 g/day).
METHODS—Six endoscopic biopsies were taken from the rectum for measurement of 5-ASA concentrations (ng/mg) by HPLC; soluble interleukin 2 receptor (sIL-2R) concentrations (U/ml) were measured by ELISA and histology. Endoscopic and histological appearance was graded on a four point scale (0-3). The Wilcoxon's rank test and Pearson's correlation coefficient were used for statistical analysis.
RESULTS—Mucosal concentrations of 5-ASA were significantly higher (p=0.03) in patients with endoscopic scores of 0-1 compared with those with scores of 2-3 (16.1 (range 10.2-45) v 5.5 (3.5-17.4), respectively) and in patients with lower histological inflammation compared with those with more severe scores (17.4 (10.5-45) v 8.9 (3.5-17.2), respectively) (p<0.01). In contrast, mucosal sIL2-R concentrations were significantly lower in patients with slight endoscopic and histological lesions than in those with more severe disease. A significative inverse correlation (r=−0.85) was found between 5-ASA and sIL-2R mucosal concentrations (p=0.00008).
CONCLUSIONS—In patients with UC, in the same area of the intestinal tract, we found that the higher the 5-ASA mucosal concentrations, the lower the IL-2R levels and endoscopic and histological scores. We hypothesise that maintenance of high mucosal 5-ASA concentrations in all colonic segments could contribute to improve clinical outcome in UC patients.


Keywords: ulcerative colitis; 5-aminosalicylic-acid; interleukin 2

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Figure 1  .

Figure 1  

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Distribution of 5-aminosalicylic acid (5-ASA) mucosal concentrations according to endoscopic and histological grading of colitis

Figure 2  .

Figure 2  

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Distribution of soluble interleukin 2 receptor (sIL-2R) mucosal concentrations according to endoscopic and histological grading of colitis.

Figure 3  .

Figure 3  

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Correlation between mucosal concentrations of 5-aminosalicylic acid (5-ASA) and soluble interleukin 2 receptor (sIL-2R).

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