Sucralfate Retention Enemas in Solitary Rectal Ulcer Showkat Ali Zargar, M.D., D.M., Mohammad Sultan Khuroo, M.D., D.M., Rakesh Mahajan,-M.D. From the Department of Gastroenterology, Institute of Medical Sciences, Srinagar (Kashmir), India Zargar SA, Khuroo MS, Mahajan R. Sucralfate retention enemas in solitary rectal ulcer. Dis Colon Rectum 1991;34:455-457. The conservative treatment of solitary rectal ulcer is gen- erally unsatisfactory. Six patients, aged 27-54 years, with recurrent solitary rectal ulcer were treated with topical administration of sucralfate in a daily dose of 2 g twice a day for 6 weeks. Four patients experienced complete relief of symptoms and the remaining two patients had marked improvement. Although macroscopic healing of the ulcer was apparent in all, histologic improvement was not appreciable. Five of the six patients remain in remission during a follow-up period of 4-14 months (mean, 8 - 1.5 months). Recurrence was observed in one patient at 5 months, which satisfactorily resolved with sucralfate enemas. From these preliminary observa- tions we infer that solitary rectal ulcer can be effectively treated with topical application of sucralfate. [Key words: Sucralfate; Solitary rectal ulcer] S olitary rectal ulcer (SRU) is a rare but dis- tressing condition that usually affects young adults. >3 There is no general agreement about its treatment and many empiric therapeutic ap- proaches have been tried including local electro- cautery, caustic agents, antibiotics, sulfasalzine, ste- roid retention enemas, and local excisional sur- gery, without any obvious or consistent improvement.i, 3 Surgical correction of prolapse of the rectum may be useful in the cases in which it is present. 4 Sucralfate is a locally acting nonsys- temic cytoprotective agent that has been effective in promoting the healing of gastric and duodenal ulcers.5, s We, therefore, decided to undertake a pilot study in patients with SRU to assess whether topical administration of sucralfate serves any ther- apeutic effect. MATERIALS AND METHODS From January 1989 to December 1989, six con- secutive patients with a diagnosis of SUR based on Address reprint requests to Dr. Khuroo: Professor and Chairman, Department of Gastroenterology, and Head, Department of Medicine, Institute of Medical Sciences, P.O. Box 27, Srina- gar (Kashmir) 190 011 India. the typical sigmoidoscopic appearances and histo- logic criteria 2' 3 were seen (Table 1). Symptoms of blood and mucus in stools, altered bowel habits, tenesmus, and abdominal or perineal pain were scored on a 10-point scale. The duration of symp- toms ranged from 4 to 48 months (mean, 18 months). Rectal bleeding was the most common complaint (n = 6), followed by mucus in the stools (n = 4), tenesmus (n = 4), diarrhea (n = 3), constipation (n -- 3), and pain (n = 2). All denied history of rectal digitation. Previous treatments had been generally unsatisfactory. The relapse-free period with previous therapies varied from 2 to 4 months (mean, 2.8 months). Rectal prolapse was seen in one patient. Sig- moidoscopy revealed a single ulcer in five patients and two ulcers in one patient. Ulcers were oval or linear in shape, shallow with slough, and measured 1.5-3.0 cm in diameter. Ulcers were located on the anterior rectal wall, 5-11 cm from the anal verge. The mucosa around the ulcer was slightly nodular in two patients. Each patient was advised to administer sucralfate, 2 g suspended in 30 ml of tap water, twice a day for 6 weeks in the form of retention enemas. The treatment was extended to 8 weeks if the ulcer did not heal with 6-week therapy. Each patient was instructed how to instill the solution through a soft rubber catheter. None reported major leakage of the instillate. Patients had been off all drugs for at least a week before starting sucralfate enemas. Pa- tients were assessed clinically every week, by flex- ible instrument sigmoidoscopy every 2 weeks by the same endoscopist, and by repeat biopsies at 6 weeks. RESULTS Four patients achieved complete relief of symp- toms (complete clinical remission) and two near- complete remission. Although the latter two pa- tients continued to have mucus in stools (n = 2) and diarrhea (n = 1), they were fairly satisfied with 455