S1751 Curcumin Enema as a Novel Adjunctive Treatment in Distal Ulcerative Colitis

Introduction: Mesalamine suppositories are a standard therapy for distal ulcerative colitis (UC), but some patients exhibit incomplete responses and frequent relapses. Curcumin, a natural polyphenol from turmeric, has emerged as a promising adjunctive therapy due to its anti-inflammatory and mucosal-healing properties. It suppresses pro-inflammatory cytokines (tumor necrosis factor [TNF]-α, interleukin [IL]-6), reduces neutrophil infiltration and restores tight junction proteins (e.g., occludin). These mechanisms align with the localized pathology of distal UC and maximize therapeutic impact. This study compared the efficacy and safety of mesalamine suppository monotherapy vs mesalamine combined with curcumin enema in patients with active distal UC. Methods: In this single-center, randomized, open-label trial, 60 adults aged 18–65 years with confirmed mild-to-moderate distal UC (rectum/sigmoid colon involvement) and active disease (partial Mayo score 2–6, endoscopic score ≥1) were divided into: Group A (n = 30): Mesalamine 1 g suppository nightly. Group B (n = 30): Mesalamine 1 g suppository nightly + curcumin 1 g enema early morning. Primary outcome included clinical remission and endoscopic healing (Mayo endoscopic score ≤1) at 8 weeks. Secondary outcomes included biomarker improvement (C-reactive protein, fecal calprotectin) and adverse effects (AEs). Results: Clinical remission: Sixty percent (18/30) in Group B vs 36.7% (11/30) in Group A (*P = 0.048*). Endoscopic healing: 53.3% (16/30) in Group B vs 30% (9/30) in Group A (*P = 0.041*). Biomarkers: Group B showed greater reductions in fecal calprotectin (Δ = 412 μg/g vs Δ = 210 μg/g; *P = 0.003*) and CRP (Δ = 8.2 mg/L vs Δ = 3.1 mg/L; *P = 0.015*). Safety: No severe AEs. Mild rectal discomfort (13% Group B vs 10% Group A) and transient bloating (10% Group B) resolved spontaneously. Conclusion: This study demonstrates that combining curcumin enema with mesalamine suppository enhances mucosal healing and symptom control in distal UC. The 60% remission rate in Group B aligns with prior trials using oral curcumin 4, but this is the first to validate its efficacy in enema form. Cardinal findings include: Mechanistic Synergy: Curcumin’s NF-κB inhibition complements mesalamine’s anti-inflammatory effects, amplifying mucosal repair. Localized Delivery: Direct enema administration bypasses curcumin’s poor oral bioavailability, achieving higher colonic tissue concentrations. Safety: Minimal AEs reinforce curcumin’s role as a low-risk adjunct, even in biologic-refractory cases (e.g., sample case studies).