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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