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Patients with ulcerative colitis who don't respond to short term corticosteroids or immunosuppressants such as azathioprine or 6-mercaptopurine are left with few safe treatment options. So researchers have begun evaluating a new strategy designed to replace a missing chemical in patients' colonic mucous.
Phosphatidylcholine is essential for a properly functioning mucosal barrier and can be replaced with an oral capsule formulated to protect its contents from digestion. In a small preliminary trial, four capsules a day improved symptoms and helped patients with refractory ulcerative colitis to withdraw corticosteroids. After 12 weeks of treatment, 12 of 30 patients who took the phosphatidylcholine were better and steroid free compared with only three of the 30 patients who took placebo capsules (P=0.015). Endoscopy findings were also improved, although mucosal healing was evident in only a handful of patients, perhaps because the study was so short. Bloating was the most common side effect—it was reported by 11 of 29 patients in the phosphatidylcholine group and six of the 30 controls.
The authors are encouraged by these early findings. Bigger and longer trials are likely to follow.