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PubMed1971

A clinico-immunological study of ulcerative colitis and ulcerative proctitis.

Fifteen patients with ulcerative colitis and 11 patients with ulcerative proctitis have been observed and studied for periods ranging from one to 15 years. It is suggested that the clinical course of the two disorders is quite distinct. Further, while the serum immunoglobulins were within normal limits in ulcerative proctitis, significant increases in the serum alpha(2)-, beta-, and gamma-globulins and in the IgA and IgG concentrations were found in ulcerative colitis. Despite total colectomy for ulcerative colitis, the serum IgG and IgA concentration remained high and even after subsequent rectal resection the relative IgA concentration continued to increase. The significance of these findings is discussed.

Adolescent↗
PubMed2001

Medical management of ulcerative proctitis, proctosigmoiditis, and left-sided colitis.

Ulcerative colitis distal to the splenic flexure includes disease confined to the rectum (proctitis), rectosigmoid (proctosigmoiditis or distal colitis), or extending to the descending colon or splenic flexure (left-sided colitis). These subtypes represent up to 60% to 80% of newly presenting cases of ulcerative colitis. Although these conditions are defined by the extent of colon that is affected, they also share the characteristic of being amenable to topical therapy. In general, the course of disease is milder and symptoms are less severe than in patients with more extensive colonic involvement. Nonetheless, symptoms may significantly impair patients' health-related quality of life. Treatment options include the oral and/or rectal 5-aminosalicylate (5-ASA) preparations. Rectal therapy delivering higher concentrations of active medication (5-ASA or glucocorticoids) directly to the inflamed mucosa while minimizing systemic absorption provides a highly effective and safe treatment. Oral glucocorticoids are indicated in patients who are resistant to or intolerant of 5-ASA therapy. Immunomodulators have an important role in individuals with glucocorticoid dependent or glucocorticoid refractory disease. This article reviews the clinical diagnosis and current medical management of ulcerative proctitis, proctosigmoiditis, and left-sided ulcerative colitis, including patients resistant to conventional medical therapy.

Administration, Oral↗
PubMed1992

[Efficacy of a daily application of mesalazine (Pentasa) suppository with progressive release, in the treatment of ulcerative proctitis. A double-blind versus placebo randomized trial].

Therapeutic efficacy of mesalazine controlled-release suppository 1 g once daily was compared with that of a placebo during 2 weeks in 50 patients (26 in the mesalazine group, 24 in the placebo group) with ulcerative proctitis, in a double-blind randomized trial. Endoscopic and clinical remission was seen in 69 and 65% of mesalazine-treated patients and in 33 and 25% of placebo-treated patients respectively (P < or = 0.01). No side effects were seen. It is concluded that a once-a-day administration of 1 g mesalazine controlled-release suppository is effective for topical treatment of patients with ulcerative proctitis.

Adult↗
PubMed1962

Observations on idiopathic proctitis.

This paper presents the natural history of idiopathic proctitis and concludes that this disease and idiopathic procto-colitis are two manifestations of one disease differing only in the extent of the colon involved.

Chronic Disease↗
PubMed1984

Systemic herpes simplex virus type 2 infection. Proctitis, urinary retention, arthralgias, and meningitis in the absence of primary mucocutaneous lesions.

A 24-year-old heterosexual man had severe proctalgia associated with nonspecific proctitis. Within a few days, perineal and lower extremity paresthesias, intermittent urinary retention, inguinal lymphadenopathy, lower extremity arthralgias, and aseptic meningitis developed. Serologic studies demonstrated a fourfold rise in convalescent antibody titer to herpes simplex virus (HSV) consistent with an initial type 2 infection. Six months later, HSV type 2 was isolated from perianal vesicles, which we believe was the first cutaneous manifestation of a recurrence. This unusual syndrome, presumably the result of HSV ganglionitis, could be confused with other disorders that include multiple sclerosis, lumbar disk disease with radiculopathy, rheumatologic disease, and psychogenic illness. In the absence of typical herpetic mucocutaneous vesicles, serologic studies may be useful in the diagnosis of a systemic herpes simplex infection.

Adult↗
PubMed1989

Argon laser treatment of radiation proctitis.

Radiation therapy for malignant gynecologic disease and prostatic cancer has resulted in increased survival and cure rates. This modality has unfortunately produced debilitating radiation proctitis. Recently, five patients were seen with continuous rectal bleeding secondary to radiation disease of the rectum. Four of these patients were women who were being treated for cervical carcinoma and one was a man with prostatic cancer. These patients were refractory to steroid retention enemas, iron therapy, and benproperine enema therapy. Treatment was accomplished using the argon laser with a 300-micron fiber passed via flexible fiberoptic sigmoidoscope. The most proximal areas were treated first. One and a half watts at 0.5 pulses was used. Up to 50 pulses were delivered per therapy session. The fiber was placed in contact with the lesion and circumferentially for 0.5 cm surrounding each suspected area. Bleeding stopped in the four women after two sessions and in the man after four sessions.

Ambulatory Surgical Procedures↗
PubMed1984

Ischaemic proctitis and adventitial fibromuscular dysplasia of the superior rectal artery.

A case of ischaemic proctitis apparently caused by adventitial fibromuscular dysplasia of the superior rectal artery is reported and the results of a survey of 50 superior rectal and marginal arteries from post mortem and surgical cases are described. Abnormal musculature was demonstrated in varying degree in the adventitia of 28 of 50 asymptomatic patients. Our findings indicate that a spectrum of this vascular abnormality exists in the elderly which is rarely severe enough to contribute to symptomatic large bowel ischaemia.

Adolescent↗
PubMed1982

Proctitis cystica profunda and radiation fibrosis in the rectum of the female Wistar rat after X irradiation: a histopathological study.

Part of the rectum of the female Wistar rat was X-irradiated (1500 rad-3000 rad) without surgery. In the early phase (second week after irradiation) radiation damage of the rectum was haemorrhagic radiation proctitis and in the late phase a rectal obstruction. The dose-effect relationship using rectal obstruction as the end point is a sigmoid curve with a LD50 of 2150 rad. Latency time decreases with increasing dose and is 150 days at the LD50. Histopathologic findings revealed excessive submucosal radiation fibrosis and numerous mucosal glands and cysts within the fibrotic submucosa. As the time after irradiation increased the extension of submucosal mucinous glands increased and sometimes the entire submucosa was replaced completely by mucosal glands and cysts. It is suggested that invasion of mucosal epithelium into the submucosa was allowed by manifold fragmentation of the muscularis mucosae due to lymphocysts having developed immediately after irradiation. The small arteries showed proliferation of the endothelium and adventitia, thickening and hyalinization of the wall, resulting in severe narrowing and even occlusion of the lumen.

Animals↗
PubMed1977

Idiopathic proctitis. I. The morphology of proximal colonic mucosa and its clinical significance.

A group of 31 patients with idiopathic proctitis were colonoscoped while they were symptomatic. Multiple mucosal biopsies were taken from the transverse, descending, and sigmoid colon and from the rectum. While visualization by colonoscopy revealed abnormalities limited to the most distal 18-20 cm of the colon, microscopic abnormalities were frequently seen in more proximal locations. Analysis of clinicopathological data indicates that there is good correlation between the extent of microscopic mucosal abnormalities and the clinical course. Patients with abnormalities limited to the rectum generally responded well to conventional treatment while patients with more proximal involvement were refractory to such therapy.

Adult↗
PubMed1977

Syphilitic proctitis.

Two adult male homosexuals with syphilitic proctitis and without any detectable anal lesions are reported. There was no history or evidence of an external primary chancre in either patient. Of note, one had extensive rectal involvement of the first 20 cm and the other had multiple sites involved. One patient developed severe rectal bleeding following biopsy and a Jarisch-Herxheimer reaction after the first penicillin injection. Salient features of the literature are reviewed and discussed.

Adult↗
PubMed1992

Proctitis cystica profunda in paraplegics. Report of three cases.

Proctitis cystica profunda is a benign disease of the rectal mucosa that can be mistaken for rectal carcinoma both grossly and microscopically. Symptoms may consist of blood or mucus in the stool, diarrhea, tenesmus, or rectal pain. The disease has never been reported in a paraplegic population before, but the proposed etiology makes this group seem to be at high risk. We report three cases in our paraplegic population and discuss the nature of the disease as well as its treatment.

Adult↗
PubMedDate not supplied

Cytomegalovirus proctitis in a diabetic.

We describe an unusual case of cytomegalovirus (CMV) proctitis in an elderly adult with uncontrolled diabetes mellitus, who had not received immunosuppressive therapy. Barium study and computed tomography showed large ulceration and sinus tract involving the rectum. CMV colitis is thought to occur almost exclusively in immunosuppressed persons. In a nonimmunosuppressed host, the infection is rarely reported.

Cytomegalovirus Infections↗
PubMed2003

Treatment of hemorrhagic radiation proctitis with 4 percent formalin.

PURPOSE: The purpose of this study was to review our results in patients undergoing treatment with 4 percent formalin for radiation-induced injury to the rectum. METHODS: A retrospective review of office charts was performed, identifying all patients undergoing formalin treatment. Patient gender, initial malignancy, prior treatments, response to treatment with formalin, complications, and length of follow-up were reviewed. All patients had flexible endoscopy to assess for proximal sources of bleeding. The indication for treatment was a symptomatic patient with endoscopic evidence of radiation injury. A cotton pledget was used for direct application of 4 percent formalin to the affected area via a rigid proctoscope or anoscope. The treatment was repeated if blanching did not occur or if bleeding continued. Patients were followed up at three-week to four-week intervals and treatment was repeated based on the above indications. Treatments were continued until cessation of bleeding occurred or, when treatment failed, operative treatment was required. RESULTS: Thirty-six patients were identified. Three were lost to follow-up. Symptoms included bleeding in all but one patient, who presented with an ulcer. There were 33 (26 male) patients. Seventeen (51.5 percent) patients had prior treatment. The number of formalin treatments ranged from 1 to 13, with a mean of 3.4. The follow-up ranged from 1 to 60 months, with a mean of 18 months. Twenty-nine (88 percent) patients had improvement or cessation of symptoms. Four (12 percent) patients failed treatment. Two patients were noted to have full-thickness ulcers and both failed formalin treatment. No complications were noted related to formalin treatment. CONCLUSION: We conclude that formalin therapy is a safe and effective form of treatment that can be performed in the office with minimal discomfort and no complications. It can be performed multiple times until results are achieved. Formalin therapy may be useful as a first-line treatment for chronic radiation proctitis, however, a prospective controlled trial comparing modalities is required to prove this to be true.

Colonoscopy↗
PubMed1995

Intrarectal formalin application, an effective treatment for grade III haemorrhagic radiation proctitis.

Haemorrhagic radiation proctitis (HRP) is infrequently seen amongst the patients who are either undergoing or have undergone radiotherapy to the pelvis. We treated 16 documented cases of HRP, who did not respond to conventional steroid retention enemas, with 4% formalin application. It was observed that the rectal bleeding was controlled completely in 81% cases in median follow up of 11 months (range 6-17 months) and diversion colostomy could be avoided in all the cases. The effectiveness of local formalin application in severe HRP is described in this article.

Administration, Rectal↗
PubMed1996

The ileocecal reservoir for rectal replacement in complicated radiation proctitis.

BACKGROUND/AIMS: Total rectal resection is the radical treatment method for radiation proctitis complications. Park's straight colo-anal reconstruction to replace the rectum often impairs anal continence, increases stool frequency, and causes imperative urgency. We developed and assessed a colo-anal reconstruction (ileocecal reservoir) after resection of radiation-damaged rectum. METHODS: An ileocecal segment was isolated on its lymphovascular pedicel, rotated counterclockwise, and reanastomosed at the dentate line. This provided a neorectal segment with intact intrinsic and extrinsic nerve and lymphovascular supply. We evaluated the safety, defecation quality, and anorectal function of this neorectum in two radiation-injured patients when compared with 15 patients after total mesorectal excision without radiation damage. RESULTS: No perioperative morbidity related to this technique was observed. Neorectal patients showed good defecation quality with maximal tolerable volumes, compliances, and anal manometry comparable with patients without radiation injury. CONCLUSIONS: This rectal replacement technique permits good defecation quality and excellent anorectal function.

Adult↗
PubMed2000

Topical butyrate for acute radiation proctitis: randomised, crossover trial.

BACKGROUND: No available therapy has, as yet, proven effective to treat acute radiation proctitis (ARP) following radiation therapy for malignant pelvic disease. We assessed whether sodium butyrate enemas, at a dose of 80 mmol/L (80 mL/24 h), might offer effective treatment for this condition. METHODS: 20 patients presenting with ARP after completing a cycle of 35-52 Gy external-beam radiation therapy for pelvic malignant disease, were treated for 3 weeks with topical sodium butyrate and saline enemas according to a randomised, double-blind, crossover protocol. Clinical, endoscopic, and histological findings were assessed at enrollment, at week 3, and then at the end of the study. Data were analysed by two-tailed t test for paired data (continuous variables) and a logistic-regression model with variable multiple response for ordered categorical data. FINDINGS: Topical butyrate, but not saline, led to remission of symptoms (clinical score from 8.2 [SE 1.6] to 1.5 [0.7] vs 7.9 [1.8] to 8.1 [3.4]). When the treatment regimen was switched, eight out of nine of the previously placebo-treated patients went into remission, whereas three patients relapsed when switched to saline. The advantage of butyrate over placebo, expressed as CI, odds ratio, and p value was significant for almost all the clinical, endoscopic and histological factors taken into consideration. INTERPRETATION: Topical sodium butyrate, unlike other therapeutic regimens used so far, proved effective in the treatment of ARP.

Administration, Topical↗