• inflammatory bowel disease
• steroids
• ulcerative colitis
• Crohn's disease

Corticosteroids remain the benchmark therapy for moderate to severe ulcerative colitis and Crohn's disease but are problematic due to unacceptable side effects and lack of maintenance benefits. Developments in corticosteroid chemistry have led to a series of anti-inflammatory glucocorticoids with enhanced topical (mucosal) potency and less systemic activity^1–,⁴ such as prednisolone-metasulphobenzoate, beclomethasone diproprionate, tixocortol pivalate, fluticasone, and budesonide. To date, budesonide has been the primary alternative compound to hydrocortisone and prednisolone marketed in many parts of the globe and, most recently, has been introduced in an ileal release formulation in the USA.^3,5

For many years, topical (rectal) steroids have had a primary role in the treatment of distal ulcerative colitis^6,7 and have been incorporated as an adjunctive treatment to parenteral steroids for treatment of severe colitis.^8,9 The relative potency of rectally applied steroids is increased compared with a similar systemic exposure, providing evidence that the …