Ulcerative colitis and phosphatidylcholine (PC) in the gut

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What goes wrong in ulcerative colitis

Digesting, fermenting food and the bacteria that go with it are highly irritant to the gut wall. Indeed, faeces are very irritant generally – one gram of faeces contains a trillion bacteria and if you stuck some onto your skin, then that area of skin would become ulcerated. We protect the lining of our gut with a mucous covering. This is a barrier between the gut wall and its contents. Mucus combines with bile acids, which act as a detergent so the contents of the small intestine are almost foamy. In the last section of the small intestine bile acids are removed, leaving phosphatidylcholine (PC), which sticks avidly to mucus that lines the gut. This has a lubricant and energy delivering action. Phosphatidylcholine is actively secreted into the small intestine but not the large intestine. Here it is gradually broken down by gut bacteria as it travels down the large bowel and indeed the rectum is the last area of supply for PC.

Research shows that lack of phosphatidylcholine (PC) is the problem

Dr W. Stremmel, a German physician, has done research that shows how ulcerative colitis is associated with a lack of PC in the lining of the large intestine, so there is no longer an effective barrier between the wall of the large bowel and the faeces. Ulcerative colitis patients had 70% less PC in rectal mucus compared to healthy controls (and interestingly Crohn’s disease patients). Stremmel hypothesises that lack of PC in large bowel mucus is a key pathogenic factor in ulcerative colitis.

This may well explain why ulcerative colitis always starts in the rectum (where PC is lowest) and moves up to the rest of the large bowel. The small intestine is never affected because this secretes PC. These patients have consistently low levels of PC because it is reduced more than 70% in the rectal mucus. The mucus becomes thin, faeces come into direct contact with the gut wall and this causes ulceration.

Treatment with PC works well

Dr Stremmel has developed a slow release form of PC, combined with bile acids which he has called Endragil 500. This supplies slow release PC which becomes available in the large bowel. In a trial of patients with ulcerative colitis who were given 4 x 500mg of this product daily, the PC in the rectum normalised, 27/30 experienced high rate improvement or complete remission, the response to therapy began within four weeks and continued to twelve weeks. See [[1]]

There is clearly a relationship between ulcerative colitis and gut flora because we know that in many cases of ulcerative colitis bacteroides are not present. Dr Stremmel hypothesises that bacteria in the gut progressively destroy phospholipids in the mucus and it is only bacteroides, the major friendly bacteria in the gut, that does not. Indeed, bacteroides produce butyric acid, which nourishes the gut wall directly and is markedly anti-inflammatory.

Endragil 500 is not yet available on the market. It should become available in 2012. Taking lecithin by mouth would not do the job simply because it is digested and absorbed. I suggested to Dr Stremmel that lecithin be given per rectum, possibly emulsified with bile acid and his comment was that this should work fine so long as there was not such severe diarrhoea that this could not be retained. Another possibility would be to use PC in colonic irrigation fluid. This is certainly something that could be easily tried with minimal potential for harm.


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