In order to investigate the role of sucralfatein active ulcerative colitis, 60 patients wererandomized to receive either sucralfate enemas (20 g/100ml) or methylprednisolone enemas (20 mg/100 ml). The enemas were administered twice daily for oneweek, and then once daily for three weeks. Clinicalevaluation was documented at entry and at two weeks andfour weeks. The sigmoidoscopic appearance of the rectal mucosa was scored, and rectal biopsiestaken at entry and at four weeks. Results indicatedsimilar reduction in diarrhea and rectal bleeding at twoweeks and at four weeks. Sigmoidoscopy demonstrated similar significant improvement in themacroscopic appearance of the rectal mucosa in bothgroups (8.28 to 6.20 in sucralfate group, P < 0.02;and 8.72 to 6.36 in the methylprednisolone treatedgroup, P < 0.04). Histologic assessment, likewise,showed similar improvements in the two groups. Thisstudy indicates that sucralfate enemas may be useful inthe treatment of ulcerative proctosigmoiditis.