Ulcerative Proctitis
Proctitis:
 • Affects 1/3 patients
 ...
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Description

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



#Ulcerative #Proctitis #IBD #diagnosis #management #algorithm 
Contributed by

Dr. Gerald Diaz
@GeraldMD
Board Certified Internal Medicine Hospitalist, GrepMed Editor in Chief 🇵🇭 🇺🇸 - Sign up for an account to like, bookmark and upload images to contribute to our community platform. Follow us on IG:  https://www.instagram.com/grepmed/ | Twitter: https://twitter.com/grepmeded/
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