Use of bromelain for mild ulcerative colitis.

To the Editor Uleerative eolitis is a chronic condition characterized by inflammation of the mucosal layer of the colon. Despite multiple treatments, some patients continue to be symptomatic and seek alternative iherapy. We describe two patients who achieved clinical and endoseopic remission after initiation of bromelain supplementation. A 67-year-old woman with a history of ulcerativc proctitis continued to have three to four bk)ody bowel movements per day despite adequate doses of sulfasalazinc, mesaiamine, 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. Endtiscopy performed at that time revealed healed mucosa. The second patient is a 60-ycar-old woman with a history of left-sided disease; her symptoms continued despite azathioprine, 2 mg/kg of body weight, and topical mesaiamine. 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. Bromeiain is a proteolytic enzyme isolated from the pineapple stem. Anecdotal use of bromclain alone includes the successful treatment of inflamed joints, dental pain, and postsurgieal pain and inflammation, presumably through an anti-inflammatory mechanism, inhibition of platelet aggregation, or flbrinolytic activity. Published reports on bromelain use refer to experimental animal models of inflammation (1) and one double-blinded study iiLJbumans revealing efficacy ui healing noninfectious cystitis (2). Bromeiain in the treatment of infectious colitis with cnterotoxigenic Escherichia coli has recently been described (3). This therapy had a proteolytic effcet on the specific receptors of K88'" cnterotoxigenic E. coli in the small intestines of piglets, thereby preventing bacterial attachment and subsequent infection. In ulcerative colitis, bromelain may act by way of flbrinolysis, a mechanism not unlike that reported in previous trials with heparin (4, 5).