technetium-tc-99m-sulfur-colloid and Colitis--Ulcerative

Ileorectal anastomosis (IRA) is a possible surgical treatment for hyperacute and drug-unresponsive forms of ulcerative colitis (UC). UC relapses in the rectal remnant usually are prevented by chronic administration of 5-aminosalicylic acid (5-ASA) in topical formulations. The relationships between intestinal absorption and pattern of luminal spread of 5-ASA enemas are still unknown in patients with IRA. We correlated the absorption of a 5-ASA enema with its spread in the distal bowel of patients with IRA as assessed by 99mTc radioenema imaging.. Eight patients with UC in remission and previous IRA received a therapeutic 50-mL 5-ASA enema labeled with 99mTc-sulfer colloid. Absorbed 5-ASA and its major metabolite, acetyl 5-ASA, were measured in plasma, and dynamic images of radiolabeled enema were obtained for 6 h. The retrograde ileal spread (RIS) was determined and expressed as percentage of total enema radioactivity. Plasma levels of 5-ASA and acetyl 5-ASA were measured in six healthy volunteers after administration of the same enema volume with no radiolabeling.. The mean 5-ASA plasma level was 0.70 microg/mL (range 0.37-0.95 microg/mL) in patients and 0.96 microg/mL (range 0.78-1.16 microg/mL) in healthy volunteers (P = not significant), and the mean acetyl 5-ASA plasma levels were 0.89 microg/mL (range 0.44-1.19 microg/mL) and 0.84 microg/mL (range 0.51-1.02 microg/mL), respectively (P = not significant). Radioenema imaging allows RIS assessment of patients with IRA. The mean value was 8.5% (range 2%-19.3%) of administered radioactivity, which correlated significantly with the total absorption of 5-ASA in the IRA group (P = 0.033, linear correlation test). Rectal wall contractions recognized by dynamic radioenema imaging were defined as a common cause of RIS episodes.. In IRA patients, 5-ASA plasma levels were similar to those in healthy volunteers after administration in enema. Only part of a 50-mL 5-ASA enema reaches the ileum, and radiolabeled imaging shows the degree and number of these RIS episodes. The absorption of 5-ASA can increase in patients compared with healthy volunteers, in the presence of either occasional but significant ileal spread associated with postural factors and abdominal wall contraction or multiple moderate episodes of radioenema backdiffusion related to rectal wall motility.

Topics: Adult; Aged; Anastomosis, Surgical; Colitis, Ulcerative; Enema; Female; Humans; Ileum; Intestinal Absorption; Male; Mesalamine; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Rectum; Technetium Tc 99m Sulfur Colloid; Time Factors

Rectal treatment with mesalazine enemas is the first-line therapy for distal ulcerative colitis. In order to improve the benefits of rectal therapy, a new 60 mL 5-ASA rectal gel enema preparation has been developed using a device which excludes direct contact of the inert propellant gas with the active drug. The purpose of the present study was to assess by scintigraphy the colonic distribution of this new mesalazine rectal gel enema.. Twelve patients with active ulcerative colitis were administered 4 g of the mesalazine rectal enema labelled with 100 MBq technetium sulphur colloid (99mTc-SC). Anterior scans of the abdomen were acquired at intervals for 4 h. Scans were analysed to evaluate the extent of retrograde flow and homogeneity of distribution of the radiolabelled enema in the rectum, sigmoid, descending and transverse colon. In addition, plasma levels of 5-ASA and Ac-5-ASA were measured for 6 h.. All patients retained the entire rectal gel throughout the course of the study without reporting adverse events. In 11 out of 12 patients (92%) the gel had spread homogeneously beyond the sigmoid colon and had reached the upper limit of disease in all cases. The maximum spread (splenic flexure) was observed in 6 out of 12 patients (50%) within the first 2 h. The systemic absorption of mesalazine and its metabolite Ac-5-ASA was low.. The new mesalazine enema represents an adequate alternative and a further technological improvement in the topical treatment of distal ulcerative colitis.

Topics: Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal; Colitis, Ulcerative; Colon; Enema; Female; Humans; Intestinal Absorption; Male; Mesalamine; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

The efficacy of mesalazine enemas depends on intraluminal concentration of the drug and is therefore limited by the enema distribution in the colon. Active ulcerative colitis changes colon motility and this leads to uncertainty about enema spread.. To assess the influence of disease activity on enema distribution, we conducted a physician-blinded, longitudinal study of the retrograde spread of three mesalazine enemas.. Thirty-one patients with mild to moderate ulcerative colitis were subdivided into three groups, and treated with 2 g mesalazine in 30 mL (group I, n = 10), 4 g mesalazine in 60 mL (group II, n = 12) or 1 g mesalazine in 100 mL (group III, n = 9). All patients received oral mesalazine 500 mg t.d.s. Enemas were labelled by adding 10 MBq (99mTc)technetium-sulphur colloid. Anterior scintigraphic images were taken at the start of the study and after 12 weeks of therapy; retrograde spread was assessed by calculating the percentage of the enema in each colonic segment.. The activity score of ulcerative colitis diminished significantly after 12 weeks of treatment, but five patients dropped out of the study. At the start of treatment enema activity in group I was mainly concentrated in the sigmoid (99%); in group II activity was found in the rectum (9%), the sigmoid (61%) and the descending colon (15%); in group III activity was distributed between the sigmoid (66%) and descending colon (25%). The colonic distribution of mesalazine enemas was not influenced by disease activity.. Volume, but not disease activity, is the important determinant of retrograde colonic spread of mesalazine enemas in ulcerative colitis.

Topics: Adult; Aminosalicylic Acids; Anti-Inflammatory Agents, Non-Steroidal; Colitis, Ulcerative; Colon; Colonoscopy; Enema; Female; Humans; Longitudinal Studies; Male; Mesalamine; Radionuclide Imaging; Rectum; Technetium Tc 99m Sulfur Colloid

Mesalamine (5-aminosalicylic acid), a topically administered anti-inflammatory agent, is effective treatment by enema for distal ulcerative colitis; it lacks many of the side effects of orally administered sulfasalazine. In this study, we determined the colonic distribution of a 60-ml mesalamine enema in eight patients (five women and three men, 18 to 48 years old) with active distal ulcerative colitis that ranged from 12 to 40 cm proximal to the anal verge. On 3 consecutive days, each patient self-administered a 4-g (60-ml) 5-aminosalicylic acid enema that contained 3.7 MBq of [99mTc]technetium-sulfur colloid. Anterior and posterior images were obtained at 0, 30, 60, 120, and 240 minutes. During the 4-hour study period, all patients retained the enemas. The enemas spread to the sigmoid region in 24 of 24 studies, to the splenic flexure region in 22 of 24, and to the transverse colon in 1 of 24. Most of the enema was retained in the sigmoid colon. Therefore, we conclude that a 60-ml enema, when administered as recommended clinically, routinely flows retrograde as far as the splenic flexure but rarely spreads beyond this point. These results support the use of intrarectally administered 5-aminosalicylic acid for segmental colitis of the descending colon.

Topics: Adolescent; Adult; Aminosalicylic Acids; Colitis, Ulcerative; Colon, Sigmoid; Enema; Female; Humans; Male; Mesalamine; Middle Aged; Proctitis; Radionuclide Imaging; Rectum; Self Administration; Technetium Tc 99m Sulfur Colloid

Although scintigraphic pelvic pouch emptying scans have been used to evaluate neorectal function in patients who have undergone colectomy, mucosal proctectomy, and ileoanal pouch anastomosis, previous reports have not documented the reliability of this test in measuring pouch volume and emptying. Thus, this study was undertaken to determine: (1) the reliability of this test in patients with stable functional results and, (2) whether the emptying fraction correlates with the volume of the pouch. Ten patients who had stable functional results had 99m Tc-sulphur colloid pouch emptying scans performed on two occasions, one week apart. The average volume of artificial stool that was instilled was 338 +/- 104 cc. The mean difference in the volume instilled between the initial and repeat scans was 78 +/- 26 cc and the mean absolute difference in the percentage evacuated was 12 +/- 9 percent. These inter-test differences were not statistically significant (p greater than 0.05). There was no correlation between the volume of artificial stool instilled into the pelvic pouch and the fraction spontaneously emptied (r = -0.1). Our results suggest that the 99m Tc-sulphur colloid pelvic pouch emptying scan is reliable in patients with stable functional results. Pouch emptying fraction is independent of pouch volume.

Topics: Adult; Colitis, Ulcerative; Female; Humans; Ileostomy; Ileum; Male; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Colectomy, mucosal rectectomy, and ileal pouch-anal anastomosis have become alternatives to proctocolectomy and ileostomy for patients with ulcerative colitis or polyposis coli. The aim of this study was to develop a scintigraphic technique for assessment of the "neorectal" motor function of such patients. An artificial stool, consisting of a 7.5% dispersion of aluminum magnesium silicate in water, was labeled with 1 mCi [99mTc]sulfur colloid and instilled into the neorectum. Static pre- and postevacuation scans and dynamic acquisition scans during evacuation were taken with the patient seated on a commode. The imaging provided good anatomic definition of the pouch and quantitated the usual rate and percentage of neorectal evacuation at about 10 ml stool/sec and 60% of instilled stool, respectively. This technique appeared to be a safe, simple, useful tool for assessing the neorectal motor function of patients with ileal pouch-anal anastomosis.

Topics: Adult; Aluminum Compounds; Aluminum Silicates; Colitis, Ulcerative; Female; Gastrointestinal Motility; Humans; Intestinal Polyps; Magnesium Compounds; Male; Middle Aged; Radionuclide Imaging; Rectum; Silicates; Technetium Tc 99m Sulfur Colloid

A hydrocortisone suspension enema was radiolabeled with [99mTc]technetium sulfur colloid and administered to four normal subjects and eight patients with varying degrees of inflammatory bowel disease. The extent of enema spreading was monitored using external scintigraphy for a period of up to 4 hr after administration. Pretreatment of normal subjects with an evacuation enema resulted in spreading of the radiolabeled enema throughout the entire colon. In seven of the eight patients studied, the enema migrated a distance equal to or greater than the extent of disease involvement. An in vivo stability study with an indium-111-labeled enema, using the perturbed angular correlation technique, revealed that the enema retains its stability for up to 90 min after administration. These results indicate that the use of hydrocortisone enemas may not be restricted to distal bowel disease, but may also be effective in inflammatory bowel diseases involving proximal regions of the colon.

Topics: Colitis, Ulcerative; Crohn Disease; Drug Stability; Enema; Humans; Hydrocortisone; Indium; Male; Radioisotopes; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Time Factors