Bromelain for Ulcerative Colitis
Clinical Briefs
With Comments from John La Puma, MD, FACP
Bromelain for Ulcerative Colitis
July 2000; Volume 3; 84
Source: Kane S, Goldberg MJ. Use of bro-melain for mild ulcerative colitis. Ann Intern Med 2000;132:680.
"A 67-year-old woman with a history of ulcerative colitis continued to have three to four bloody bowel movements per day despite adequate doses of sulfasalazine, mesal-amine, and topical steroids. She discovered bromelain at a nutrition/herbal store after researching digestive aids’ and anti-inflammatory drugs. Within a week of taking two tablets of bromelain at each meal, she was having one formed bowel movement per day without blood or urgency. Endoscopy performed at that time revealed healed mucosa.
The second patient is a 60-year-old woman with a history of left-sided disease; her symptoms continued despite azathioprine, 2 mg/kg of body weight, and topical mesalamine. She had heard about bromelain from a friend who used it for colonic health.’ After she took several doses, her diarrhea improved. Endoscopy revealed quiescent disease affecting the splenic flexure."
COMMENT
Because ulcerative colitis is a difficult-to-treat chronic condition, and because the drugs used to do so often have adverse effects, an effective, benign supplement would be especially useful.
Bromelain is the proteolytic enzyme present in pineapple juice; other enzymes are present in other tropical fruit, especially papain, a mixture of proteolytic enzymes found in a species of a papaya.
Bromelain has been reported to be used in the treatment of infectious colitis, and in noninfectious cystitis and post-traumatic conditions of swelling and inflammation. The authors speculate that bromelain may act as a fibrinolytic agent, as heparin appears to do in ulcerative colitis as well. It is also suspected that bromelain causes the release of a kinin, stimulating prosta-glandin E1 compounds. In theory, bromelain may also increase the risk of bleeding when taken with other anticoagulants and antiplatelet drugs.
Food as medicine will be seen more in the coming years, but less in whole food form than in capsules. Can you imagine Dole Pineapples becoming Dole UC Relief? Not a chance. But bromelain tabs right next to sulfasalazine on a formulary? Easily imaginable.
Recommendation
Case reports of bromelain effectiveness are not enough to prescribe it in addition to pharmaceuticals, but they are enough to stimulate a serious research trial, and these should. Except in patients on anticoagulant/antiplatelet drugs and those at risk for pregnancy, be open minded and careful about its use.
July 2000; Volume 3; 84
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