Introduction Diversion colitis, a nutritional deficiency disease of short chain fatty acids (SCFAs) in the defunctioned rectum, responds to butyrate enemas but these are impracticable due to unpleasant malodour. Treatment with rapidly fermentable fibre to SCFAs as suppositories, seemed a preferable option and was tested.
Methods “Hi-maize 260” which is naturally high in resistant starch and is optimally fermented to n-butyrate in the colon1 was formulated into 2.0 g suppositories with a binding agent of cocoa butter. Patients were selected on symptoms (blood stained discharge, or anorectal discomfort) for treatment. Suppositories were used on alternative nights for 14 days. Colonoscopic examination of the rectum was performed before and 6 days after completion of treatment.
Results “Hi-maize 260” produces a concentration of 20.3 mmol of butyrate in the colon. The diverted rectum of three patients showed severe macroscopic proctitis and mucosal appearances returned to normal after 2 weeks treatment. Long term recovery was not assessed as two patients had the diversion reversed.
Conclusion Dietary fibre suppositories are a convenient treatment for diversion colitis. The healing capacity of fermentable fibre should enable distinction between diversion colitis and ulcerative colitis or Crohn's Disease in a diverted rectum where further reconnection or proctectomy might be contemplated.
Competing interests None declared.
Reference 1. Le Leu RK, et al. Effect of high amylose maize starches on colonic fermentation and apoptotic response to DNA-damage in the colon of rats. Nutr Metab 2009;6:11–20.