From the Guidelines
Rectal diclofenac is generally contraindicated in patients with ulcerative colitis. Patients with active ulcerative colitis should avoid using rectal NSAIDs like diclofenac suppositories because these medications can exacerbate intestinal inflammation and potentially trigger disease flares. NSAIDs inhibit cyclooxygenase enzymes, reducing protective prostaglandins in the gastrointestinal mucosa, which can worsen mucosal damage and increase intestinal permeability in patients with inflammatory bowel disease 1.
Some key points to consider:
- The use of non-selective NSAIDs, including diclofenac, can increase the risk of gastrointestinal complications, such as bleeding ulcers, in patients with a history of gastrointestinal events or those taking anticoagulation therapy or corticosteroids 1.
- The risk of gastrointestinal complications in NSAID users over the age of 65 years is increased approximately 2–3.5-fold when compared with younger patients 1.
- For pain management in ulcerative colitis patients, acetaminophen (paracetamol) is typically a safer alternative for mild to moderate pain.
- If stronger pain control is needed, consultation with a gastroenterologist is recommended to develop an appropriate pain management strategy that won't worsen the underlying condition.
- Patients with ulcerative colitis who have been prescribed NSAIDs for other conditions should discuss alternative pain management options with their healthcare provider to avoid potential complications and disease exacerbation.
It's also important to note that the guidelines for the management of mild-to-moderate ulcerative colitis do not recommend the use of rectal diclofenac, and instead suggest the use of mesalamine enemas or suppositories for patients with mild-moderate ulcerative proctosigmoiditis or proctitis 1.
Overall, the use of rectal diclofenac in patients with ulcerative colitis is not recommended due to the potential risk of exacerbating intestinal inflammation and triggering disease flares. Alternative pain management options should be discussed with a healthcare provider to ensure the best possible outcome for the patient.
From the Research
Rectal Diclofenac in Ulcerative Colitis
- There is no direct evidence in the provided studies that rectal diclofenac is contraindicated in patients with ulcerative colitis 2, 3, 4, 5, 6.
- The studies focus on the treatment of ulcerative colitis using 5-aminosalicylic acid (5-ASA) compounds, corticosteroids, and other therapies, but do not mention rectal diclofenac specifically 2, 3, 4, 5, 6.
- However, it is known that nonsteroidal anti-inflammatory drugs (NSAIDs), including diclofenac, can exacerbate inflammatory bowel disease (IBD) symptoms in some patients 2, 3.
- The use of rectal therapies, such as suppositories and enemas, is discussed in the context of treating distal forms of ulcerative colitis, but these therapies typically involve 5-ASA or corticosteroids, not NSAIDs like diclofenac 5, 6.
Treatment Options for Ulcerative Colitis
- The primary treatment options for ulcerative colitis include 5-ASA compounds, corticosteroids, thiopurines, biological agents, and Janus kinase inhibitors 2, 3, 4.
- Rectal therapies, such as 5-ASA suppositories and enemas, are effective for treating distal forms of ulcerative colitis and can be used alone or in combination with oral treatments 5, 6.
- The choice of treatment depends on the extent and severity of the disease, as well as the patient's response to previous treatments 2, 3, 4.