ULCERATIVE PROCTITIS

SYMPTOMS

Symptoms of ulcerative proctitis can vary in severity and may include:

• Rectal bleeding: Passage of bright red blood from the rectum, often mixed with stool or seen on toilet paper, is a common symptom of ulcerative proctitis.
• Rectal pain: Discomfort, pain, or aching sensation in the rectum or anus, particularly during bowel movements, may occur due to inflammation and ulceration.
• Urgency: Urgent need to have a bowel movement, often accompanied by a feeling of incomplete evacuation or tenesmus.
• Diarrhea: Increased frequency of bowel movements and loose, watery stools may occur during disease flares.
• Rectal discharge: Mucus or pus may be present in the stool or passed from the rectum, reflecting inflammation and mucosal irritation.
• Constipation: Some individuals with ulcerative proctitis may experience constipation or difficulty passing stools, particularly if rectal inflammation leads to narrowing or stricture formation.
• Abdominal discomfort: Mild abdominal cramping, bloating, or discomfort may be present, especially during disease flares or exacerbations.

DIAGNOSIS

Diagnosing ulcerative proctitis typically involves a combination of clinical evaluation, endoscopic examination, and histological assessment of rectal tissue. Diagnostic steps may include:

• Medical history: A thorough medical history is obtained to assess for symptoms, disease duration, previous treatments, family history of inflammatory bowel disease, and potential triggers or exacerbating factors.
• Physical examination: Abdominal examination and digital rectal examination (DRE) are performed to assess for signs of abdominal tenderness, rectal inflammation, or rectal strictures.
• Endoscopic evaluation: Flexible sigmoidoscopy or colonoscopy with biopsy may be performed to visualize the rectum and distal colon, assess the extent and severity of inflammation, and obtain tissue samples for histological examination.
• Histopathological analysis: Microscopic examination of rectal biopsies allows for confirmation of inflammation, assessment of disease activity, and differentiation from other causes of rectal pathology such as infectious colitis or ischemic colitis.
• Laboratory tests: Blood tests, including complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and stool studies (fecal calprotectin) may be ordered to assess for markers of inflammation and rule out infectious causes of gastrointestinal symptoms.

TREATMENT

Management of ulcerative proctitis aims to reduce inflammation, control symptoms, and induce remission to prevent disease progression and complications. Treatment options may include:

• Topical therapies: Rectal medications such as 5-aminosalicylic acid (5-ASA) suppositories or enemas are often used as first-line therapy to deliver anti-inflammatory agents directly to the inflamed rectal mucosa.
• Oral medications: Oral 5-ASA medications (e.g., mesalamine) or corticosteroids may be prescribed to reduce inflammation and induce remission, particularly in cases of more extensive disease or inadequate response to topical therapy.
• Immunomodulators: Immunomodulatory medications such as azathioprine, 6-mercaptopurine, or methotrexate may be considered for individuals with moderate to severe ulcerative proctitis or those requiring long-term maintenance therapy.
• Biologic agents: Biologic therapies, including anti-tumor necrosis factor (TNF) agents (e.g., infliximab, adalimumab) or integrin inhibitors (e.g., vedolizumab), may be recommended for individuals with refractory or corticosteroid-dependent disease.
• Antibiotics: Antibiotics may be prescribed in cases of concurrent bacterial infection or to reduce bacterial overgrowth in the colon, particularly if there is evidence of infectious complications or perianal involvement.
• Symptomatic relief: Symptomatic relief measures such as antidiarrheal medications (e.g., loperamide), analgesics, or dietary modifications (e.g., low-residue diet) may be recommended to alleviate symptoms such as diarrhea, abdominal pain, or rectal discomfort.
• Surgery: Surgical intervention may be considered for individuals with severe ulcerative proctitis refractory to medical therapy, complications such as severe bleeding, perforation, or toxic megacolon, or those with dysplasia or malignancy.