P3255 - Curcumin Enema as a Novel Adjunctive Treatment in Distal Ulcerative Colitis

Award: ACG Presidential Poster Award

Md. Shakhawat Hossain, MD¹, Maknun Nahar, MPH², Md. Makhsudul Alam, MD¹
1Rangpur medical college, Rangpur, Rangpur, Bangladesh; 2Bangladesh Open University, Rangpur Sadar, Rangpur, Bangladesh

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 (TNF-α, IL-6), reduces neutrophil infiltration¹ and restores tight junction proteins (e.g., occludin). ² These mechanisms align with the localized pathology of distal UC and maximize therapeutic impact. ³ This study compared the efficacy and safety of mesalamine suppository monotherapy versus 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 1g enema early morning.

Primary outcome included clinical remission and endoscopic healing (Mayo endoscopic score ≤1) at 8 weeks. Secondary outcomes included biomarker improvement (CRP, fecal calprotectin) and adverse effects (AEs).

Results: Clinical remission: 60% (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.

Discussion: 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:

1. Mechanistic Synergy: Curcumin’s NF-κB inhibition complements mesalamine’s anti-inflammatory effects, amplifying mucosal repair.
2. Localized Delivery: Direct enema administration bypasses curcumin’s poor oral bioavailability, achieving higher colonic tissue concentrations.

3.Safety: Minimal AEs reinforce curcumin’s role as a low-risk adjunct, even in biologic-refractory cases (e.g., sample case studies).

Figure: Table:Efficacy of Curcumin enema adjunctive therapy in distal ulcerative colitis:


Figure: Table:Efficacy of Curcumin enema adjunctive therapy in distal ulcerative colitis:

Disclosures:
Md. Shakhawat Hossain indicated no relevant financial relationships.
Maknun Nahar indicated no relevant financial relationships.
Md. Makhsudul Alam indicated no relevant financial relationships.

Md. Shakhawat Hossain, MD¹, Maknun Nahar, MPH², Md. Makhsudul Alam, MD¹. P3255 - Curcumin Enema as a Novel Adjunctive Treatment in Distal Ulcerative Colitis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.