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Nicotine Treatment For Ulcerative Colitis

Saraswita Gabrillah Saetikho


161610101092
Fakultas Kedokteran Gigi Universitas Jember

Abstract

Introduction: Ulcerative colitis (KU) disease is a chronic inflammatory disease of the


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).

Discussion
Ulcerative colitis is a chronic inflammation of colon that causes ulceration. Ulceration and
inflammation of the lining of the colon causes symptoms of abdominal pain, diarrhea, and rectal
bleeding. This condition is associated with intestinal inflammation called Crohn's disease
(Guslandi,1999).
Ulcerative colitis and Crohn's disease are chronic conditions that can last for years to decades,
beginning during adolescence and early adulthood or childhood. Inflammation in the colon also
causes the bowel is often empty, causing diarrhea. Ulcerative colitis is an inflammatory bowel
disease or IBD (Jugde,2003)
Tobacco chemical content that has been identified amounted to 2,500 components. 1,400
others decomposed or split, acting with other components and forming new components and
forming new components all of which form approximately 4,800 chemical components in the
smoke. In tobacco chemical content included (Susilowati,2006).

1. Nitrogen compounds (nicotine, protein).


Nicotine (-pyridyl--N-methyl pyrrolidine) is a specific organic compound contained in tobacco
leaves. Nitric Oxide in nicotine can reduce the activity of circular muscle activity, the release of
nitrates in the intestinal wall can also ward off inflammatory bowel disease. Protein makes the
flavor very intense and biting, so during the processing (curing) this compound should be
overhauled into other senayawa such as amides and amino acids.
2. Carbohydrate compounds (starch, pectin, cellulose, sugar).
Starch, pectin, and cellulose are high-powered compounds that harm the aroma and taste of suction,
so that during the processing must be overhauled into sugar. Sugar has a role in relieving heavy
feeling in cigarette butts if too high causes heat and esophageal irritation, and causes tobacco to
absorb moisture (moisture) so damp.
3. Resins and essential oils.
Leaf sap that is in the hairs of leaves contains resin and essential oils, in the burning will cause a
fragrant smell of cigarette smoke. Tobacco also has active ingredients as anti-bacteria and fungi
among other classes of phenol in the form of flavonoids, alkanoid groups of nicotine, saponins in
the form of steroids as well as atsiri form of terpenoid oil.
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 but inconclusive results. In
open trials, 16 patients with left-sided colitis who received various types of therapy (mesalazine,
sulphasalazine, steroids) and given 30 mg of nicotine daily were given transdermal fillings for 4
weeks. The majority of patients report clinical, endoscopic and histologic improvement during
nicotine administration (Guslandi, 1999).
A multicentre, double blind, placebo-controlled trial conducted in the UK was demonstrated
in patients with ulcerative colitis who had applied transdermal nicotine (15-25 mg daily for 6
weeks) in addition to continuous therapy (oral mesalazine or corticosteroids). superior in terms of
clinical and histological improvement. Similar results have been reported by multicentre controlled
trials conducted in the United States, where in 4 weeks 39% of patients receiving transdermal
nicotine reported clinical improvement - as assessed by the 13-point disease activity index
measuring stool frequency, rectal bleeding, endoscopic findings and clinical global evaluation -
compared with 9% of patients receiving
placebo (Guslandi, 1999).
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.

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