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United European Gastroenterology Journal Oct 2020
Topics: Cohort Studies; Colitis, Ulcerative; Humans; Mesalamine; Proctitis; Referral and Consultation
PubMed: 32741314
DOI: 10.1177/2050640620948795 -
Minerva Gastroenterologica E Dietologica Sep 2020Proctitis is an inflammation involving the anus and the distal part of the rectum, frequently diagnosed in the context of inflammatory bowel diseases (IBD).... (Review)
Review
Proctitis is an inflammation involving the anus and the distal part of the rectum, frequently diagnosed in the context of inflammatory bowel diseases (IBD). Nevertheless, when the standard therapy for IBD is ineffective, it becomes necessary for the clinician to review alternative etiologies, beginning from the broad chapter of infectious causes up to rare causes such as radiation, ischemia, diversion and traumatisms. While it is possible to find infectious proctitides caused by pathogens generally inducing extensive colitis, the growing incidence of both sexually transmitted infections and isolated proctitis reported in the recent years require a lot of attention. The risk appears to be higher in individuals participating in anal intercourse, especially men having sex with men (MSM) or subjects who use sex toys and participate to sex parties, dark rooms and so on. The commonest implicated pathogens are Neysseria gonorrhoeae, Chlamydia trachomatis, Herpes Simplex virus and Treponema pallidum. Herpes and Chlamydia infections mainly occur in HIV-positive MSM patients. Since symptoms and signs are common independently from etiology, performing a differential diagnosis based on clinical manifestations is complicated. Therefore, the diagnosis is supported by the combination of clinical history and physical examination and, secondly, by endoscopic, serologic and microbiologic findings. Particular emphasis should be given to simultaneous infections by multiple organisms. The involvement of experts in infectious diseases and in sexual health is crucial for the diagnostic and therapeutic management. The available therapies, empirically initiated or specific, in many cases are able to guarantee a good prognosis and to prevent relapses.
Topics: Humans; Inflammatory Bowel Diseases; Proctitis
PubMed: 32218425
DOI: 10.23736/S1121-421X.20.02670-7 -
International Journal of Colorectal... Oct 2015The purpose of this study was to give an overview of the measures used to prevent chronic radiation proctitis (CRP) and to provide an algorithm for the treatment of CRP. (Review)
Review
OBJECTIVE
The purpose of this study was to give an overview of the measures used to prevent chronic radiation proctitis (CRP) and to provide an algorithm for the treatment of CRP.
METHODS
Medical literature databases including PubMed and Medline were screened and critically analyzed for relevance in the scope of our purpose.
RESULTS
CRP is a relatively frequent late side effect (5-20%) and mainly dependent on the dose and volume of irradiated rectum. Radiation treatment (RT) techniques to prevent CRP are constantly improving thanks to image-guided RT and intensity-modulated RT. Also, newer techniques like protons and new devices such as rectum spacers and balloons have been developed to spare rectal structures. Biopsies do not contribute to diagnosing CRP and should be avoided because of the risk of severe rectal wall damage, such as necrosis and fistulas. There is no consensus on the optimal treatment of CRP. A variety of possibilities is available and includes topical and oral agents, hyperbaric oxygen therapy, and endoscopic interventions.
CONCLUSIONS
CRP has a natural history of improving over time, even without treatment. This is important to take into account when considering these treatments: first be conservative (topical and oral agents) and be aware that invasive treatments can be very toxic.
Topics: Chronic Disease; Humans; Proctitis; Radiation Injuries; Radiotherapy; Radiotherapy Dosage
PubMed: 26198994
DOI: 10.1007/s00384-015-2289-4 -
BMJ Case Reports Jun 2017
Topics: Adult; Anus Diseases; Diagnosis, Differential; Herpes Simplex; Humans; Male; Proctitis
PubMed: 28663248
DOI: 10.1136/bcr-2017-220856 -
Journal of Crohn's & Colitis Nov 2022Proctitis is the least extensive type of ulcerative colitis, for which rectal therapy is rarely studied and is underused. This study evaluated the efficacy, safety, and... (Randomized Controlled Trial)
Randomized Controlled Trial
Novel Budesonide Suppository and Standard Budesonide Rectal Foam Induce High Rates of Clinical Remission and Mucosal Healing in Active Ulcerative Proctitis: a Randomised, Controlled, Non-inferiority Trial.
BACKGROUND AND AIMS
Proctitis is the least extensive type of ulcerative colitis, for which rectal therapy is rarely studied and is underused. This study evaluated the efficacy, safety, and patient's preference of a novel formulation of budesonide suppository 4 mg, compared with a commercially available budesonide rectal foam 2 mg, for the treatment of mild to moderate ulcerative proctitis.
METHODS
This was a randomised, double-blind, double-dummy, active-controlled trial. Patients were randomly assigned in a 1:1 ratio to receive either budesonide 4 mg suppository or budesonide 2 mg foam once daily for 8 weeks. The co-primary endpoints were changes from baseline to Week 8 in clinical symptoms, for which clinical remission was defined as having a modified Ulcerative Colitis-Disease Activity Index [UC-DAI] subscore for stool frequency of 0 or 1 and a subscore for rectal bleeding of 0, and mucosal healing, defined as having a modified UC-DAI subscore for mucosal appearance of 0 or 1. Using a more stringent criterion, we additionally analysed deepened mucosal healing, which was defined as a mucosal appearance subscore of 0. Patient's preference, physician's global assessment, and quality of life were also assessed and analysed.
RESULTS
Overall, 286 and 291 patients were included in the 4 mg suppository and 2 mg foam groups, respectively. Budesonide 4 mg suppository met the prespecified criterion for non-inferiority to the 2 mg foam in both co-primary endpoints of clinical remission and mucosal healing. Secondary endpoints consistently supported the non-inferiority of the suppository. Trends in favour of the suppository were observed in the subgroup of mesalazine non-responders. More patients reported a preference for the suppository over rectal foam.
CONCLUSIONS
In patients with ulcerative proctitis, budesonide 4 mg suppository was non-inferior to budesonide 2 mg foam in efficacy, and both were safe and well tolerated.
Topics: Humans; Budesonide; Colitis, Ulcerative; Quality of Life; Treatment Outcome; Mesalamine; Proctitis; Double-Blind Method; Remission Induction
PubMed: 35709376
DOI: 10.1093/ecco-jcc/jjac081 -
Postgraduate Medical Journal Nov 2006Sexually transmitted infections such as chlamydia, gonorrhoea, herpes simplex virus and syphilis commonly present with rectal symptoms. Recent outbreaks of... (Review)
Review
Sexually transmitted infections such as chlamydia, gonorrhoea, herpes simplex virus and syphilis commonly present with rectal symptoms. Recent outbreaks of lymphogranuloma venereum among homosexual men throughout Europe highlight the need to consider sexually transmitted infections in the differential diagnosis of proctitis. This article examines the causative organisms, clinical features, diagnosis and treatment of sexually transmitted proctitis.
Topics: Female; Humans; Male; Proctitis; Sexuality; Sexually Transmitted Diseases
PubMed: 17099092
DOI: 10.1136/pmj.2006.048488 -
Chirurgie (Heidelberg, Germany) Nov 2023
Topics: Humans; Ulcer; Proctitis; Rectal Diseases; Intestine, Large
PubMed: 37665361
DOI: 10.1007/s00104-023-01961-3 -
World Journal of Gastroenterology Nov 2011Chronic radiation proctopathy occurs in 5%-20% of patients following pelvic radiotherapy. Although many cases resolve spontaneously, some lead to chronic symptoms... (Review)
Review
Chronic radiation proctopathy occurs in 5%-20% of patients following pelvic radiotherapy. Although many cases resolve spontaneously, some lead to chronic symptoms including diarrhea, tenesmus, urgency and persistent rectal bleeding with iron deficiency anemia requiring blood transfusions. Treatments for chronic radiation proctitis remain unsatisfactory and the basis of evidence for various therapies is generally insufficient. There are very few controlled or prospective trials, and comparisons between therapies are limited because of different evaluation methods. Medical treatments, including formalin, topical sucralfate, 5-amino salicylic acid enemas, and short chain fatty acids have been used with limited success. Surgical management is associated with high morbidity and mortality. Endoscopic therapy using modalities such as the heater probe, neodymium:yttrium-aluminium-garnet laser, potassium titanyl phosphate laser and bipolar electrocoagulation has been reported to be of some benefit, but with frequent complications. Argon plasma coagulation is touted to be the preferred endoscopic therapy due to its efficacy and safety profile. Newer methods of endoscopic ablation such as radiofrequency ablation and cryotherapy have been recently described which may afford broader areas of treatment per application, with lower rate of complications. This review will focus on endoscopic ablation therapies, including such newer modalities, for chronic radiation proctitis.
Topics: Argon; Catheter Ablation; Cryosurgery; Disease Management; Endoscopy; Humans; Laser Coagulation; Pelvic Neoplasms; Proctitis; Radiation Injuries; Radiotherapy; Treatment Outcome
PubMed: 22147960
DOI: 10.3748/wjg.v17.i41.4554 -
American Family Physician May 2016This summary of the American Cancer Society Prostate Cancer Survivorship Care Guidelines targets primary care physicians who coordinate care of prostate cancer survivors... (Review)
Review
This summary of the American Cancer Society Prostate Cancer Survivorship Care Guidelines targets primary care physicians who coordinate care of prostate cancer survivors with subspecialists. Prostate cancer survivors should undergo prostate-specific antigen screening every six to 12 months and digital rectal examination annually. Surveillance of patients who choose watchful waiting for their prostate cancer should be conducted by a subspecialist. Any hematuria or rectal bleeding must be thoroughly evaluated. Prostate cancer survivors should be screened regularly for urinary incontinence and sexual dysfunction. Patients with predominant urge incontinence symptoms, which can occur after surgical and radiation treatments, may benefit from an anticholinergic agent. If there is difficulty with bladder emptying, a trial of an alpha blocker may be considered. A phosphodiesterase type 5 inhibitor can effectively treat sexual dysfunction following treatment for prostate cancer. Osteoporosis screening should occur before initiation of androgen deprivation therapy, and patients treated with androgen deprivation therapy should be monitored for anemia, metabolic syndrome, and vasomotor symptoms. Healthy lifestyle choices should be encouraged, including weight management, regular physical activity, proper nutrition, and smoking cessation. Primary care physicians should be vigilant for psychosocial distress, including depression, among prostate cancer survivors, as well as the potential impact of this distress on patients' family members and partners.
Topics: Adrenergic alpha-Antagonists; Aftercare; Androgen Antagonists; Cholinergic Antagonists; Cystitis; Depression; Digital Rectal Examination; Gastrointestinal Hemorrhage; Healthy Lifestyle; Hematuria; Humans; Kallikreins; Male; Mass Screening; Neoplasm Recurrence, Local; Osteoporosis; Practice Guidelines as Topic; Primary Health Care; Proctitis; Prostate-Specific Antigen; Prostatic Neoplasms; Radiation Injuries; Rectum; Survivors; Urinary Incontinence
PubMed: 27175954
DOI: No ID Found -
Zhongguo Ying Yong Sheng Li Xue Za Zhi... May 2021To investigate the effects of huaihuasan and baitouweng formular on acute radiation proctitis (ARP) in rats. Forty clean grade SD rats were randomly divided into...
To investigate the effects of huaihuasan and baitouweng formular on acute radiation proctitis (ARP) in rats. Forty clean grade SD rats were randomly divided into control group, model group, mesalazine group and formula group. Except the control group, all the other three groups received 6 MV-20 GY dose of X-ray irradiation in the pelvic cavity, and the rat model of acute radiation proctitis was established. The rats were given daily gavage intervention with the corresponding drugs after mold formation. According to the adult clinical equivalent dose (body surface area), the control group and the model group were given 10 ml/kg saline daily, the Mesalazine group was treated with Mesalazine solution at the dose of 0.27 g/kg, and the Formular group was given (0.91 g/kg) respectively for 14 days. All rats were killed on the 14th day after administration. To evaluate the general situation of the rats, HE staining was used to observe the pathological changes in the rectal tissues of the rats. The contents of intercellular adhesion molecule-1 (ICAM-1) and vascular adhesion molecule-1 (VCAM-1) were detected by Elisa, and the expression of NF-κb P65 in the tissues were detected by Western blot. Compared with the model group, in the mesalazine group and the formular group, the clinical symptoms and intestinal mucosal healing of rats were improved significantly, the expression level of NF-κB P65 protein in the rectal tissues and the serum contents of ICAM-1 and VCAM-1 were decreased with statistically significant differences (<0.05). Huaihuasan and baitouweng formular can reduce NF-κB, ICAM-1 and VCAM-1 to improve symptoms and rectal mucosal injury in ARP rats.
Topics: Animals; Intercellular Adhesion Molecule-1; Intestinal Mucosa; NF-kappa B; Proctitis; Rats; Rats, Sprague-Dawley
PubMed: 34374246
DOI: 10.12047/j.cjap.6052.2021.016