Epidermal growth factor enemas with oral mesalamine for mild-to-moderate left-sided ulcerative colitis or proctitis

N Engl J Med. 2003 Jul 24;349(4):350-7. doi: 10.1056/NEJMoa013136.


Background: Epidermal growth factor (EGF) is a potent mitogenic peptide produced by salivary glands. We examined whether EGF enemas are an effective treatment for active left-sided ulcerative colitis and ulceration limited to the rectum (proctitis).

Methods: In a randomized, double-blind clinical trial conducted at Leicester Royal Infirmary, 12 patients with mild-to-moderate left-sided ulcerative colitis received daily enemas of 5 microg of EGF in 100 ml of an inert carrier and 12 received daily enemas with carrier alone for 14 days. All also began to receive 1.2 g of oral mesalamine per day or had their dose increased by 1.2 g per day. Patients were assessed clinically at 0, 2, 4, and 12 weeks and by sigmoidoscopy and biopsy at 0, 2, and 4 weeks. The primary end point was disease remission (defined by a St. Marks score of 4 or less without sigmoidoscopic evidence of inflammation) at two weeks. Secondary end points were clinically significant improvements in disease activity (defined by a decrease of more than 3 points in the St. Marks score or the ulcerative colitis disease-activity index) at two and four weeks. Analyses were performed according to the intention-to-treat principle.

Results: After two weeks, 10 of the 12 patients given EGF enemas were in remission, as compared with 1 of 12 in the control group (83 percent vs. 8 percent, P<0.001). At the 2-week assessment, disease-activity scores, sigmoidoscopic score, and histologic scores were all significantly better in the EGF group than in the placebo group (P<0.01 for all comparisons), and this benefit was maintained at 4 weeks and at 12 weeks.

Conclusions: This study provides preliminary data suggesting that EGF enemas are an effective treatment for active left-sided ulcerative colitis.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Adult
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • Colitis, Ulcerative / drug therapy*
  • Double-Blind Method
  • Drug Therapy, Combination
  • Enema*
  • Epidermal Growth Factor / administration & dosage*
  • Epidermal Growth Factor / therapeutic use
  • Female
  • Humans
  • Male
  • Mesalamine / therapeutic use*
  • Middle Aged
  • Proctitis / drug therapy*
  • Remission Induction


  • Anti-Inflammatory Agents, Non-Steroidal
  • Mesalamine
  • Epidermal Growth Factor