~ 112007 Phosphatidylcholine Shows Promise For Ulcerative Colitis Treatment

An article published in the November 6, 2007 issue of the Annals of Internal Medicine described the outcome of a study which showed that phosphatidylcholine was superior to a placebo in the treatment of ulcerative colitis among patients for whom immunosuppressive drugs and steroid treatment were not effective. Immunosuppressive drugs such as azathioprine are recommended over corticosteroid treatment because of the latter's risks and side effects, but for those whose condition does not respond to immunosuppressive therapy, long term steroid treatment remains the only option. However, a certain number of people with the disease also fail to respond adequately to steroids.

Phosphatidylcholine is a form of the B vitamin choline which naturally occurs in lecithin. An insufficient level of phosphatidylcholine in colon mucus has been found to contribute to the genesis of ulcerative colitis. In a randomized, double-blind, placebo-controlled trial, researchers at University Hospital in Heidelberg, Germany administered 500 milligrams phosphatidylcholine four times per day or a placebo to 60 ulcerative colitis patients who had clinical activity of the disease despite long term steroid treatment, and in whom immunosuppressant therapy had failed or was poorly tolerated. The compound was encapsulated so that it was released in the distal intestine, which is the portion of the intestine that is affected in ulcerative colitis.

While just three of the thirty patients in the placebo group were able to successfully withdraw from steroid treatment and demonstrated improved clinical activity, 50 percent of the group that received phosphatidylserine achieved these study goals. Eighty percent of the group that received phosphatidylserine was able to discontinue steroid therapy without a worsening of the disease.

"In our study, phosphatidylcholine replaced steroids in 80% of patients who had chronic steroid-refractory ulcerative colitis without clinical deterioration," the authors write. "We found similar efficacy for phosphatidylcholine and immunosuppressant drugs."

"If our results are confirmed in a larger multicenter study, retarded-release phosphatidylcholine may be a valuable treatment option for ulcerative colitis and could further understanding of the disease," they conclude.

Health Concern: Ulcerative colitis

Ulcerative colitis is characterized by inflammation of the large intestine (colon) that leads to episodes of bloody diarrhea, abdominal cramping, and even fever. Unlike Crohn’s disease, ulcerative colitis usually doesn’t affect the full thickness of the intestine and never affects the small intestine. The disease usually begins in the rectum or sigmoid colon and spreads partially or completely through the large intestine.

Corticosteroids (such as prednisone and hydrocortisone) reduce inflammation. They are used to treat more severe cases of inflammatory bowel disease and to induce remission. Corticosteroids can be given orally, intravenously, or rectally (through an enema or in a suppository), depending on the location of the inflammation. These drugs can cause serious adverse effects, including increased risk of infection, high blood pressure, bone loss, kidney suppression, and ulcers. Less serious adverse effects include weight gain, acne, facial hair, and mood swings. They are not recommended for long-term use and are typically replaced with 5-ASA drugs once remission has been induced.

Glutamine is an amino acid that is frequently used as a sports and fitness supplement. It has been found to help modulate the immune system and protect the mucosal protective layer in the intestine.
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