Ulcerative Proctitis

Proctitis:

 • Affects 1/3 patients

 • Predictors of extension:

     - Disease severity

     - Corticosteroid use

     - 1 flare/year

 • Appendectomy may decrease risk of extension

 • Isolated disease ~= Increased risk colorectal CA

 • Topical therapy primary Tx modality

Refractory Proctitis:

 • Proctitis despite PO steroids and PR + PO 5-ASA

 • Consider:

     1. Poor adherence to medical therapy

     2. Inadequate drug delivery to the inflamed mucosa

     3. Proximal constipation

     4. Infection (CMV, c-Diff, GCCT (LGV), syphilis)

     5. Alternative Dx: IBS, rectal prolapse, CD, cancer

Treatment Considerations:

 • PR Mesalamine 3gm/week in divided doses effective for maintenance

 • Hydrocortisone PR systemic absorption 40%

 • PR Tacrolimus rarely associated w/ toxicity



Dr. Waseem Ahmed @Waseem_AhmedMD



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