Faecal flora of patients with ulcerative colitis during treatment with salicylazosulphapyridine.

Because the lesions of ulcerative colitis are normally in contact with large numbers of bacteria, many investigators have explored the possibility that one particular strain or species or the faecal flora as a whole is responsible for initiating or maintaining the disease process (Weinstein, 1961). Diplostreptocci (Bargen, 1924; Paulson, 1928), shigellas (Hurst, 1921; Bargen, Copeland, and Buie, 1931; Felsen and Wolarsky, 1947), bacteroides (Dack, Heinz, and Dragstedt, 1935; Dack, Kirsner, Dragstedt, and Johnson, 1939; Dragstedt, Dack, and Kirsner, 1941), and the total faecal flora (Seneca and Henderson, 1950), have been investigated but the results obtained are inconclusive, and the possible role of bacteria in this disease remains in doubt. Salicylazosulphapyridine (salazopyrine) was introduced as a treatment for ulcerative colitis in 1940, and is of considerable therapeutic value, particularly in the long-term management of the condition (Svartz, 1956; Moertel and Bargen, 1959; LennardJones, Longmore, and Jones, 1960; Watkinson, 1961). The mode of action of salazopyrine in ulcerative colitis has not been elucidated. In this disease, there are changes in the connective tissue of the colon (Levine, Kirsner, and Klotz, 1951) and salazopyrine binds selectively to connective tissue (Hanngren, Hansson, Svartz, and Ullberg, 1963). However, the possibility remains that this drug alters the colonic flora of patients with ulcerative colitis and that this may be the mechanism of its therapeutic effect. For this reason, the faecal flora of patients with ulcerative colitis on treatment with salazopyrine was studied and the results compared with those previously obtained (Cooke, 1967) for ulcerative colitis patients not on this drug.