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Nicotine Treatment For Ulcerative Colitis 2017 November 2nd
Published in final edited form as:
Nicotine Treatment For Ulcerative Colitis. 2017 November 2nd
Abstract
Introduction: Ulcerative colitis (KU) disease is a chronic inflammatory disease of colon
especially regarding the part of the colonic mucosa. This disease is one of inflammatory bowel
diseases (IBD). Discussion: Nicotine was found to suppress the function of Th2 in vivo cells as
measured by inhibition of interleukin-10 production, and to reduce the synthesis of interleukin-2
and interleukin-8 by mononuclear cells. Recent data indicate that flare-up of ulcerative colitis often
occurs earlier in steroid-treated patients than with nicotine patch treatments. Conclusions:
Transdermal nicotine alone has limited efficacy for active ulcerative colitis and is not as effective
as treatment. But when given in combination with mesalamine, more efficacious alternative
nicotine are effective and provide a therapeutic effect longer than prednisone.
Keywords
Ulcerative colitis, Colon, Inflammatory bowel diseases, Nicotine.
INTRODUCTION
Ulcerative colitis is a chronic inflammatory disease of the colon, especially concerning the
mucosal part of the colon. This disease is one of the inflammatory bowel diseases (IBD), which
until now has not known the cause clearly The cause of IBD is still unclear, but related to
genetic factors and environmental factors as a trigger this is evident from 10-20% of patients
must have family members affected by the same disease. Ulcerative colitis includes
autoimmune diseases related to the inflammatory response of bacteria in the colon. Broadly
speaking IBD consists of 3 types, namely ulcerative colitis, Crohn's disease, and if it is difficult
to distinguish between the two, it is included in the category of indeterminate colitis Ulcerative
colitis is one of two types of Inflammatory Bowel Disease, in addition to Crohn disease
(Guslandi,1999).
People who do not smoke have a great potential with Collis ulcerative disease compared to
smokers. This is because toxins called Nitric Oxide in Nicotine can reduce the activity of circular
muscle activity, the release of nitrate in the intestinal wall can also ward off inflammatory bowel
disease. (Guslandi,1999)
METHODS
I conducted literature search in Google Schoolar,with publication date limited to between 1990
and 2007,using the following medical subject heading terms; Ulcerative colitis,Colon
Inflammatory bowel diseases , Nicotine. Other literature I got from some textbooks that have
correlation to this study . the search was limited to English language and bahasa indonesia. the
title and abstract of all this papers identified by the electronic search were manually assessed by a
researcher working independently sought to find out if there were any clinical trials assesing
Nicotine treatment for ulcerative colitis.
In spite of extensive investigation, the exact mechanisms involved in the therapeutic effects of
nicotine in ulcerative colitis remain elusive. It has been reported that nicotine increases the
thickness of colonic mucus, thus enhancing the protection of the intestinal mucosa. It has been
suggested that nicotine influences the cellular and the humoral immune system and interferes
with the inflammatory response, perhaps through stimulation of endogenous steroid release
Indeed nicotine has been found to suppress in vivo Th2 cell function as measured by inhibition of
interleukin-10 production , and to reduce the synthesis of interleukin-2 and interleukin-8 by
mononuclear cells (Bhatti,1997)
DISSCUSION
Ulcerative colitis is largely a non-smoker disease, and it has been suggested that transdermal
nicotine can be a therapeutic value in active disease. Due to the many common side effects, we
developed a nicotine formulation as a therapeutic agent for ulcerative colitis. Much
epidemiological evidence that smoking protects against ulcerative colitis, The risk of developing
disease is significantly lower in smokers than non-smokers or ex-smokers. Patients with
ulcerative colitis who start smoking often have clinical elevations encouraging attempts to verify
the hypothesis that nicotine may be an active component. Initial and uncontrolled observations
using nicotine gum, a pharmaceutical form that is usually not well-tolerated, produces good
In a controlled study, patients who experienced acute ulcerative colitis flare-ups during
maintenance treatments with mesalazine were given additional treatment with transdermal
nicotine 15 mg daily or prednisone for 5 weeks and then followed for 6 months while
continuously being given mesalazine. ulcerative colitis was observed in 20% of nicotine-treated
patients and in 60% of patients in the prednisone group (P = 0.027) People treated with patches
of nicotine recurred earlier in people successfully treated with steroids, concluded from this data
that transdermal nicotine alone have limited efficacy in active and ineffective ulcerative colitis as
maintenance treatments. On the other hand, if given in combination with mesalazine, nicotine is
superior to placebo, it has been reported that nicotine increases the thickness of the colonic
mucus, thus improving intestinal mucosal protection. Nicotine affects the cellular and humoral
immune systems and interferes with the inflammatory response, through stimulation of
endogenous steroid release. Nicotine was found to suppress the function of Th2 in vivo cells as
measured by inhibition of interleukin-10 production, and to reduce the synthesis of interleukin-2
and interleukin-8 by mononuclear cells. Nitric Oxide in nicotine can also stimulate colonic
mucus and inhibition of inflammatory cytokines play a role in reducing circular muscle activity,
the release of nitrates in the intestinal wall can also counteract colitis (Guslandi, 1999).
CONCLUSION
Ulcerative colitis is a disease more commonly seen in non-smokers or former smokers. In mild to
moderate cases, the addition of transdermal nicotine to conventional therapy (usually mesalazine)
for 4-6 weeks results in clinical improvement and may also be a therapeutic alternative when
corticosteroids are unusable. Overall, the therapeutic effect of nicotine is consistent. Nicotine was
found to suppress the function of Th2 in vivo cells as measured by inhibition of interleukin-10
production, and to reduce the synthesis of interleukin-2 and interleukin-8 by mononuclear cells.
transdermal nicotine alone has limited efficacy for active ulcerative colitis and is not as effective
as treatment. But when administered in combination with mesalazine, nicotine is more efficacious
and works a longer therapeutic effect than prednisone.
Supplementary Material
Refer to Web version on Google Scholar for Supplementary material.
Acknowledgments
Firstly, I would like to express my sincere gratitude to my advisor Dr. drg. Banun Kusumawardani,
M. Kes. for the continuous support of my study, for her patience, motivation, and immense
knowledge. Her guidance helped me in all the time of writing of this Article. I could not have
imagined having a better advisor and mentor for my study.
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