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Journal of Crohn's & Colitis Mar 2024Although ulcerative proctitis [UP] can dramatically impair quality of life, treatment efficacy has been poorly investigated in UP as it was historically excluded from...
BACKGROUND
Although ulcerative proctitis [UP] can dramatically impair quality of life, treatment efficacy has been poorly investigated in UP as it was historically excluded from phase 2/3 randomised controlled trials in ulcerative colitis. Our aim was to assess the effectiveness and safety of tofacitinib for the treatment of UP.
METHODS
We conducted a retrospective, multicentre study in 17 GETAID centres, including consecutive patients with UP treated with tofacitinib. The primary endpoint was steroid-free remission between Week 8 and Week 14, defined as a partial Mayo score of 2 [and no individual subscore above 1]. Secondary outcomes included clinical response and steroid-free remission after induction and at 1 year.
RESULTS
All the 35 enrolled patients previously received anti-tumour necrosis factor [TNF] therapy and 88.6% were exposed to at least two lines of biologics. At baseline, the median partial Mayo score was 7 (intequartile range [IQR] [5.5-7]). After induction [W8-W14], 42.9% and 60.0% of patients achieved steroid-free remission and clinical response, respectively. At 1 year, the steroid-free clinical remission and clinical response rates were 39.4% and 45.5%, respectively, and 51.2% [17/33] were still receiving tofacitinib treatment. Survival without tofacitinib withdrawal was estimated at 50.4% (95% confidence interval [CI] [35.5-71.6]) at 1 year. Only a lower partial Mayo at baseline was independently associated with remission at induction (0dds ratio [OR] = 0.56 for an increase of 1, (95% CI [0.33-0.95], p = 0.03). Five [14.3%] adverse events were reported, with one leading to treatment withdrawal [septic shock secondary to cholecystitis].
CONCLUSION
Tofacitinib may offer a therapeutic option for patients with refractory UP.
Topics: Humans; Tumor Necrosis Factor Inhibitors; Retrospective Studies; Quality of Life; Proctitis; Piperidines; Pyrimidines
PubMed: 37796025
DOI: 10.1093/ecco-jcc/jjad169 -
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 -
Alimentary Pharmacology & Therapeutics May 2004Perianal fistulas are a frequent manifestation of Crohn's disease. The correct application of the newer diagnostic and therapeutic agents for treating perianal Crohn's... (Review)
Review
Perianal fistulas are a frequent manifestation of Crohn's disease. The correct application of the newer diagnostic and therapeutic agents for treating perianal Crohn's disease are beginning to be better defined. In general, a combined medical and surgical approach is preferred. The perianal disease process should first be fully delineated with endoscopy and either MRI or EUS before treatment is begun. Patients are then stratified into one of three groups: simple fistulas and no proctitis; simple fistulas and concomitant proctitis; and complex fistulas. Patients with simple fistulas and no proctitis can be treated medically with a combination of antibiotics and an immunosuppressive agent (azathioprine or mercaptopurine). Patients with simple fistulas and concomitant proctitis should have infliximab added to their treatment plan. Complex fistulas require surgical intervention first prior to medical treatment. A combination of antibiotics, immunosuppressive therapy and infliximab are then initiated to facilitate fistula healing.
Topics: Anti-Bacterial Agents; Anus Diseases; Crohn Disease; Gastrointestinal Agents; Humans; Immunosuppressive Agents; Proctitis; Rectal Fistula; Treatment Outcome
PubMed: 15113362
DOI: 10.1111/j.1365-2036.2004.01917.x -
JCI Insight May 2023BACKGROUNDDue to their immunoregulatory and tissue regenerative features, mesenchymal stromal cells (MSCs) are a promising novel tool for the management of ulcerative...
BACKGROUNDDue to their immunoregulatory and tissue regenerative features, mesenchymal stromal cells (MSCs) are a promising novel tool for the management of ulcerative proctitis (UP). Here we report on a phase IIa clinical study that evaluated the impact of local MSC therapy on UP.METHODSThirteen refractory UP patients, with an endoscopic Mayo score (EMS) of 2 or 3, were included. Seven patients received 20-40 million allogeneic MSCs (cohort 1), while 6 patients received 40-80 million MSCs (cohort 2). Adverse events (AEs) were assessed at baseline and on weeks 2, 6, 12, and 24. Clinical, endoscopic, and biochemical parameters were assessed at baseline and on weeks 2 and 6. Furthermore, we evaluated the engraftment of MSCs, the presence of donor-specific human leukocyte antigen (HLA) antibodies (DSAs), and we determined the impact of MSC therapy on the local immune compartment.RESULTSNo serious AEs were observed. The clinical Mayo score was significantly improved on weeks 2 and 6, and the EMS was significantly improved on week 6, compared with baseline. On week 6, donor MSCs were still detectable in rectal biopsies from 4 of 9 patients and DSAs against both HLA class I and class II were found. Mass cytometry showed a reduction in activated CD8+ T cells and CD16+ monocytes and an enrichment in mononuclear phagocytes and natural killer cells in biopsies after local MSC therapy.CONCLUSIONLocal administration of allogeneic MSCs is safe, tolerable, and feasible for treatment of refractory UP and shows encouraging signs of clinical efficacy and modulation of local immune responses. This sets the stage for larger clinical trials.TRIAL REGISTRATIONEU Clinical Trials Register (EudraCT, 2017-003524-75) and the Dutch Trial Register (NTR7205).FUNDINGECCO grant 2020.
Topics: Humans; Mesenchymal Stem Cell Transplantation; Mesenchymal Stem Cells; Colitis, Ulcerative; Histocompatibility Antigens Class I; Proctitis
PubMed: 36951952
DOI: 10.1172/jci.insight.167402 -
Allergy and Asthma Proceedings 2015Non-IgE-mediated food allergic disorders account for up to 40% of milk protein allergy in infants and young children. We aim to review the recent literature and to... (Review)
Review
Non-IgE-mediated food allergic disorders account for up to 40% of milk protein allergy in infants and young children. We aim to review the recent literature and to provide an update on diagnosis and management of food protein-induced enterocolitis syndrome (FPIES) and food protein-induced allergic proctocolitis (FPIAP). The peer-reviewed articles indexed in PubMed have been reviewed. FPIES manifests in infants as profuse, repetitive vomiting and lethargy, often with diarrhea, leading to acute dehydration, or weight loss and failure to thrive, in chronic form. FPIES is caused most commonly by cow's milk (CM) and soy proteins; rice, oat, and other solid foods may also trigger FPIES. FPIES rarely occurs in the exclusively breastfed infants. FPIES is underrecognized; children are often mismanaged as having acute viral gastrointestinal illness, sepsis, or surgical disease, delaying diagnosis of FPIES for many months. Approximately 25% of children with FPIES develop food-specific IgE antibodies and some transition to immediate food allergy; IgE positivity is associated with a more protracted course. FPIES is a self-limiting condition, with most cases resolving by age three to five years. Ondansetron may be helpful in managing acute FPIES. FPIAP is a benign condition of bloody stools in a well-appearing infant, with usual onset between one and four weeks of age. Up to 60% of cases occur in exclusively breastfed infants and resolve with maternal elimination of CM and soy proteins. The majority of cases resolve by age 12 months. FPIES may transition to IgE-mediated food allergy in some patients; IgE positivity to the FPIES food is a marker of a more persistent disease. FPIAP is benign and resolves by age 12 months in most patients.
Topics: Allergens; Diagnosis, Differential; Dietary Proteins; Enterocolitis; Food Hypersensitivity; Humans; Proctocolitis; Syndrome
PubMed: 25976434
DOI: 10.2500/aap.2015.36.3811 -
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 -
Clinics in Colon and Rectal Surgery Feb 2007Patients with sexually transmitted proctitides are increasingly presenting to doctors' offices. This may be secondary to increasing numbers of individuals participating...
Patients with sexually transmitted proctitides are increasingly presenting to doctors' offices. This may be secondary to increasing numbers of individuals participating in anal receptive intercourse and a rise in the incidence of sexually transmitted diseases. Although the sexually transmitted proctitides represent a small proportion of the overall number of cases of new proctitis, in certain populations the incidence of these diseases as causative agents is quite high, especially among men who have sex with men. Common causative agents include Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum, and herpes simplex. Diagnosis may often be made on clinical grounds alone, and treatment requires antibiotics or antivirals. The clinician must remember to keep these diseases in mind while formulating a differential for the cause of proctitis.
PubMed: 20011362
DOI: 10.1055/s-2007-970201 -
World Journal of Gastroenterology Aug 2016Pelvic radiation is a commonly utilized treatment for malignancy of the genitourinary and lower gastrointestinal tract. Radiation proctitis and the resultant clinical... (Review)
Review
Pelvic radiation is a commonly utilized treatment for malignancy of the genitourinary and lower gastrointestinal tract. Radiation proctitis and the resultant clinical picture varies from asymptomatic to potentially life threatening. Similarly, treatment options also vary greatly, from medical therapy to surgical intervention. Commonly utilized medical therapy includes sucralfate enemas, antibiotics, 5-aminosalicylic acid derivatives, probiotics, antioxidants, short-chain fatty acids, formalin instillation and fractionated hyperbaric oxygen. More invasive treatments include endoscopic-based, focally ablative interventions such as dilation, heater and bipolar cautery, neodymium/yttrium aluminum garnet argon laser, radiofrequency ablation or argon plasma coagulation. Despite its relatively common frequency, there is a dearth of existing literature reporting head-to-head comparisons of the various treatment options via a randomized controlled approach. The purpose of our review was to present the reader a consolidation of the existing evidence-based literature with the goal of highlighting the comparative effectiveness and risks of the various treatment approaches. Finally, we outline a pragmatic approach to the treatment of radiation proctitis. In light of the lack of randomized data, our goal is to pursue as least invasive an approach as possible, with escalation of care tailored to the severity of the patient's symptoms. For those cases that are clinically asymptomatic or only mildly symptomatic, observation or medical management can be considered. Once a patient fails such management or symptoms become more severe, invasive procedures such as endoscopically based focal ablation or surgical intervention can be considered. Although not all recommendations are supported by level I evidence, reported case series and single-institutional studies in the literature suggest that successful treatment with cessation of symptoms can be obtained in the majority of cases.
Topics: Endoscopy, Gastrointestinal; Gastrointestinal Hemorrhage; Humans; Hyperbaric Oxygenation; Metronidazole; Probiotics; Proctitis; Radiation Injuries; Sucralfate
PubMed: 27610010
DOI: 10.3748/wjg.v22.i31.6972 -
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 -
Gastroenterologie Clinique Et Biologique Apr 2007
Comparative Study Review
Topics: Administration, Oral; Adrenal Cortex Hormones; Algorithms; Anesthetics, Local; Antibodies, Monoclonal; Aspirin; Azathioprine; Biopsy; Cyclosporine; Drug Therapy, Combination; Escherichia coli; Forecasting; Gastrointestinal Agents; Humans; Immunosuppressive Agents; Infliximab; Lidocaine; Methotrexate; Nicotine; Patient Compliance; Probiotics; Proctitis; Randomized Controlled Trials as Topic; Rectum; Suppositories; Time Factors
PubMed: 17483776
DOI: 10.1016/s0399-8320(07)89398-5