Materiały źródłowe

• #1 Proctitis and Anusitis: Background, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/192910-overview

  The prevalence of proctitis in the general population has not been established through epidemiologic studies. However, it is possible to ascertain the incidence of proctitis through analysis of specific disease states. For example, patients with UC displayed a 31-50% frequency of proctitis upon diagnosis, depending on age at diagnosis. A study in the pediatric UC population demonstrated a significant increase in the occurrence of proctitis in female children as compared with males. […] The frequency of chronic radiation-induced proctitis has been reported to be in the range of 2-20% and is influenced by total radiation dose, mode of delivery, and dose fractionation. […] Infectious proctitis is typically due to sexually transmitted disease (STD) and is more common in those with a history of anal receptive intercourse. Of these infections, gonorrhea and chlamydia were the most common STDs, followed by herpes and syphilis. Some studies have reported the incidence of gonorrheal and chlamydial proctitis among men who have sex with men (MSM) to be as high as 8.5% and 7.9%, respectively.

• #2 Proctitis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/proctitis/symptoms-causes/syc-20376933

  Proctitis is common in people who have inflammatory bowel disease (Crohn’s disease or ulcerative colitis). […] About 30% of people with inflammatory bowel disease (Crohn’s disease or ulcerative colitis) have inflammation of the rectum. […] Risk factors for proctitis include: Unsafe sex. Practices that increase your risk of a sexually transmitted infection (STI) can increase your risk of proctitis. Your risk of contracting an sexually transmitted infection (STI) increases if you have multiple sex partners, don’t use condoms and have sex with a partner who has an STI. […] Radiation therapy directed at or near your rectum (such as for rectal, ovarian or prostate cancer) increases your risk of proctitis.

• #3 Proctitis | Altru Health System

  https://www.altru.org/health-library/conditions/proctitis

  Proctitis is common in people who have inflammatory bowel disease (Crohn’s disease or ulcerative colitis). […] About 30% of people with inflammatory bowel disease (Crohn’s disease or ulcerative colitis) have inflammation of the rectum. […] Risk factors for proctitis include: Unsafe sex. Practices that increase your risk of a sexually transmitted infection (STI) can increase your risk of proctitis. Your risk of contracting an STI increases if you have multiple sex partners, don’t use condoms and have sex with a partner who has an STI. […] Radiation therapy directed at or near your rectum (such as for rectal, ovarian or prostate cancer) increases your risk of proctitis.

• #4 Proctitis | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/116488/all/Proctitis

  Acute or chronic inflammation of the rectal mucosa. […] Incidence: Predominant age: adults. Predominant sex: male female. Ulcerative colitis (UC): 2 to 19 per 100,000 person-years. Gonococcal proctitis is most common in individuals 25 years of age. People of Jewish descent are 3 to 5 times more likely to have UC. Acute radiation proctitis; arises in almost all patients, self-limited, lasts up to 3 months after treatment. […] Prevalence of rectal chlamydia and rectal gonorrhea among men who have sex with men (MSM) is 9% and 5%, respectively. In children diagnosed with UC: 25% will only have ulcerative proctitis (UP). Girls are twice as likely to have UP than boys. 30% of patients with UC have isolated rectal involvement. Proximal extension of UP increases from 20% at 5 years to 84% at 20 years. Chronic radiation proctopathy (CRP): Onset ranges from 8 to 13 months but can occur many years after radiation exposure. Prevalence is 220%. Diversion proctitis (DP): Onset is usually from 3 to 36 months after fecal diversion. 50% of patients are symptomatic.

• #5 Proctitis and Anusitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK430892/

  Gonococcal and chlamydial proctitis and anusitis occur predominantly in young adults. Incidence is more in males than females. Gonococcal proctitis is most common in individuals younger than 25 years. Among men who have sex with men (MSM), prevalence rates of rectal chlamydia and rectal gonorrhea are 9% and 5% respectively. People of Jewish descent are 3-5 times more likely to develop UC and more than 30% of patients with UC have isolated rectal involvement. In children diagnosed with UC, 25% will only have ulcerative proctitis (UP). Girls are two times more likely to have UP than boys. Acute radiation proctitis and anusitis occur in the majority of patients, but are self-limited and last up to three months after the start of radiotherapy. CRP prevalence ranges from 2% to 20% and onset ranges from eight to 13 months but can occur many years after radiation exposure. DP onset is usually from three to 36 months after fecal diversion, and less than 50% of patients are symptomatic.

• #6 Ulcerative Colitis | Doctor

  https://patient.info/doctor/ulcerative-colitis-pro

  Ulcerative colitis is the most common form of inflammatory bowel disease, and the incidence and prevalence is increasing worldwide. The prevalence is estimated at 5-500 per 100,000 worldwide. […] Incidence estimates range from 0.9 to 24.3 per 100,000 person-years, and prevalence estimates range from 2.4-294 cases per 100,000 people in Europe. […] Within Europe, the highest incidence and prevalence rates are in Scandinavia and the UK. […] The incidence of childhood-onset ulcerative colitis, which represents about 15-20% of all ulcerative colitis cases, ranges from 1-4 per 100,000 per year in most North American and European regions. […] The peak incidence occurs in late adolescence and early adulthood in the second to fourth decades of life, with a small second peak in the fifth decade. Ulcerative colitis affects males and females at approximately equal rates.

• #7 Ulcerative Colitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/1101/p1323.html/1000

  Ulcerative colitis affects approximately 250,000 to 500,000 persons in the United States, with an annual incidence of two to seven per 100,000 persons. The overall incidence of the disease has remained constant over the past five decades. […] The onset of ulcerative colitis is most common between 15 and 40 years of age, with a second peak in incidence between 50 and 80 years. The disease affects men and women at similar rates. […] Patients with ulcerative colitis are at increased risk of developing colon cancer. The anatomic extent and duration of the disease correlate with the degree of risk. In one meta-analysis, investigators found that the risk of colon cancer was 2 percent in the first 10 years of ulcerative colitis, 8 percent during the first 20 years, and 18 percent during the first 30 years.

• #8 Proctitis, Proctocolitis, and Enteritis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/proctitis.htm

  Proctitis occurs predominantly among persons who have receptive anal exposures (oral-anal, digital-anal, or genital-anal). […] Genital HSV and LGV proctitis are more prevalent among persons with HIV infection. […] The clinical presentation can be mistaken for inflammatory bowel disease or malignancy, resulting in a delayed diagnosis. […] When outbreaks of gastrointestinal illness occur among social or sexual networks of MSM, clinicians should consider sexual transmission as a mode of spread and provide counseling accordingly. […] Among immunosuppressed persons with HIV infection, CMV or other opportunistic pathogens should be considered. […] Acute proctitis among persons who have anal exposure through oral, genital, or digital contact is usually sexually acquired. […] Studies have reported that behaviors that facilitate enteric pathogen transmission might be associated with acquisition of other STIs, including HIV infection.

• #9 Separating Infectious Proctitis from Inflammatory Bowel Disease—A Common Clinical Conundrum

  https://www.mdpi.com/2076-2607/12/12/2395

  Proctitis refers to inflammation in the rectum and may result in rectal bleeding, discharge, urgency, tenesmus, and lower abdominal pain. […] The incidence of infective proctitis is rising, particularly amongst high-risk groups, including men who have sex with men, those with HIV seropositive status, and those participating in high-risk sexual behaviours. […] The worldwide incidence of inflammatory bowel disease is increasing and is expected to continue to rise, particularly in middle- and low-income countries. […] As the cases of both infective and inflammatory proctitis increase globally, distinguishing between these will become an increasingly common clinical conundrum. […] The aim of this review is to identify the key features of inflammatory and infective proctitis, and to highlight the distinguishing features to assist clinicians in the diagnostic process.

• #10 Separating Infectious Proctitis from Inflammatory Bowel Disease—A Common Clinical Conundrum

  https://www.mdpi.com/2076-2607/12/12/2395

  The most commonly isolated organisms causing infective proctitis are Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum, herpes simplex virus, Mycoplasma genitalium, and Mpox. […] There are many overlapping features between infective and inflammatory proctitis, and, consequently, a high index of suspicion is required. […] Failure of initial treatment should always lead a clinician to reconsider the original diagnosis. […] In patients with risk factors and/or atypical features, failure to consider infective proctitis can lead to delayed diagnosis, the inadvertent initiation of immunosuppressive treatment, and complications that could be avoided.

• #11 Proctitis, Proctocolitis, and Enteritis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/proctitis.htm

  Evidence-based interventions for preventing acquisition of sexually transmitted enteric pathogens are not available. […] Persons with HIV infection and acute proctitis might present with bloody discharge, painful perianal ulcers, or mucosal ulcers and LGV and herpes proctitis are more prevalent among this population.

• #12 STI-associated syndromes guide: Proctitis – Canada.ca

  https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/canadian-guidelines/sti-associated-syndromes/proctitis.html

  Mpox should also be considered as a possible cause of proctitis. From April 28, 2022 until September 29, 2023, 1,515 cases of mpox were reported in Canada, disproportionately impacting gay, bisexual and other men who have sex with men. […] Outbreaks of extensively drug resistant Shigella species (XDR Shigella) and other enteric infections have occurred among sexual networks of gbMSM in high-income countries in recent years.

• #13 Radiation proctitis: Clinical manifestations, diagnosis, and management – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-treatment-of-radiation-proctitis

  Radiation proctitis occurs during or within six weeks of radiation therapy. Reliable estimates of the incidence of radiation proctitis are not available due to variability in the definition and reporting of radiation proctitis. However, the incidence of radiation proctitis in patients treated with brachytherapy alone is estimated to range from 8 to 13 percent and up to 21 percent when used in combination with other modalities. […] Chronic radiation injury may occur as a continuation of acute radiation proctitis or have a delayed onset (from 9 to 14 months following radiation exposure to 30 years after exposure). The reported incidence of chronic radiation injury ranges from 2 to 20 percent. […] Risk factors for radiation proctitis include the dose of radiation, area of exposure, and method of delivery. Doses of radiation <45 Gy are associated with few long-term radiation side effects. In contrast, doses between 45 and 70 Gy cause more complications, and doses above 70 Gy cause significant and longstanding injury to the surrounding area.

• #14 EM@3AM: Proctitis – emDocs

  https://www.emdocs.net/em3am-proctitis/

  Epidemiology: […] Proctitis: Inflammation of distal 10-12 cm of the anal canal occurring secondary to inflammation, infection, free radicals, cellular damage. […] Half of all patients with pelvic malignancies will receive radiation. […] Acute radiation proctitis occurs in up to 20% of patients, necessitating interruption of radiation treatment. […] Chronic radiation proctitis occurs with an incidence of 5-11%. […] Occurs 8-12 months after treatment despite radiation cessation. […] Radiation proctitis can be associated with fistulous tracts and low grade obstructions. […] […] […] Laboratory evaluation: […] CBC with differential. […] Fecal occult blood test. […] Fecal calprotectin: Levels correlate with proctitis severity in radiation proctitis.

• #15 Proctitis

  https://www.eviq.org.au/Clinical-resources/Side-effect-and-toxicity-management/Gastrointestinal/421-Proctitis

  Exact figures vary, but it is widely accepted that most patients receiving pelvic irradiation will develop some degree of acute radiation proctitis and approximately 1-5% of patients will experience chronic radiation proctitis. […] The condition is probably underreported, as patients may be reluctant to report symptoms due to embarrassment or a belief that nothing can be done about them. […] There is also evidence that the occurrence and/or severity of acute radiation proctitis may be predictive of the development of chronic radiation proctitis. […] The primary approach to the prevention of radiation proctitis is to minimise the radiation dose to the rectum through highly conformal treatment using image-guided radiation therapy (IGRT) and intensity-modulated radiation therapy (IMRT) and/or volumetric arc therapy (VMAT).

• #16 Sexually transmitted infections manifesting as proctitis | Frontline Gastroenterology

  https://fg.bmj.com/content/4/1/32

  There is a rising incidence of several sexually transmitted infections (STIs), many of which can present with proctitis. […] In the UK and many other western countries there has been a sustained annual increase in the incidence of sexually transmitted infections (STIs) over the past decade. […] Several STIs including gonorrhoea, chlamydia, syphilis and herpes virus can manifest with symptoms and endoscopic features of proctitis. […] GUM or infectious disease specialists should be consulted in suspected or confirmed cases of LGV. […] Current European guidance on the management of LGV recommends doxycyline 100mg twice a day for 21days first line, or erythromycin 500mg four times a day for 21days. […] Routine screening using NAAT in GUM clinics detects rectal chlamydia in approximately 10% of MSM and 5% of women.

• #17 STI-associated syndromes guide: Proctitis – Canada.ca

  https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/canadian-guidelines/sti-associated-syndromes/proctitis.html

  Proctitis caused by sexually transmitted infections (STI), including sexually transmitted enteric infections (STEI), disproportionately impact gay, bisexual and other men who have sex with men (gbMSM). Rectal STI and STEI may increase the risk for HIV acquisition. […] Since the 1970s, increased transmission and outbreaks of Shigella sonnei and Shigella flexneri have been documented among sexual networks of gbMSM, and antibiotic-resistant Shigella was included in the World Health Organization’s 2017 list of antibiotic-resistant „priority pathogens” that pose significant public health threats. […] Rates of infectious syphilis have increased in Canada in recent years and outbreaks have been declared in most provinces and territories since 2017. Consider syphilis in people presenting with proctitis.

• #18 Sexually transmitted infections manifesting as proctitis | Frontline Gastroenterology

  https://fg.bmj.com/content/4/1/32

  Co-infection with other sexually transmitted pathogens is common and so full sexual health screening including HIV, hepatitis B and C is advisable. […] Sexual health experts should be consulted in cases of confirmed or suspected STI, when further screening for co-infection including HIV, hepatitis B and C should then be undertaken, along with tests of cure and partner identification as appropriate.

• #19 From random to precise: updated colon cancer screening and surveillance for inflammatory bowel disease – Fatakhova – Translational Gastroenterology and Hepatology

  https://tgh.amegroups.org/article/view/8700/html

  Patients with inflammatory bowel disease (IBD) are at increased risk of developing colorectal cancer (CRC). […] The risk of CRC in patients with IBD is one third higher than in the general population. […] In western countries, over the past 30 years, the incidence of CRC related death in the IBD population has been decreasing. […] One study showed that the relative risk of CRC in ulcerative colitis (UC) patients decreased from 1.34 to 0.57. […] IBD related CRC only accounts for about 12% of all cases of CRC but IBD is one of the 3 major risk factors for CRC. […] In 2001, Eaden et al., in their meta-analysis estimated that the cumulative risk of CRC in patients with UC was 2% at 10 years, 8% at 20 years and 18% at 30 years. […] However, over a decade later, Lutgens et al., in their meta-analysis reported that the incidence of CRC amongst patients with IBD has declined and was 1%, 2% and 5% after 10, 20 and 20 years of disease duration respectively.

• #20 From random to precise: updated colon cancer screening and surveillance for inflammatory bowel disease – Fatakhova – Translational Gastroenterology and Hepatology

  https://tgh.amegroups.org/article/view/8700/html

  The risk of CRC also increases with disease severity and duration. […] In UC, there is a 10-15-fold increased risk of CRC with pancolitis and a two-fold increased risk with left sided UC. […] Primary sclerosing cholangitis (PSC) is an independent risk factor for colon malignancy in patients with IBD. […] The correlation between PSC and UC is stronger than that with Crohns disease (CD). […] The occurrence of concurrent PSC in UC patients is reported to be as high as 8%, but this varies by the extent of the disease. […] The prevalence is thought to be close to 6% in patients with pancolitis, but 1% in patients with distal colitis. […] The reason for the increased risk is unknown. […] It is important to note that aggressive surveillance should not be ceased after liver transplantation in patients with PSC, as these patients continue to be at high risk for CRC.

• #21 From random to precise: updated colon cancer screening and surveillance for inflammatory bowel disease – Fatakhova – Translational Gastroenterology and Hepatology

  https://tgh.amegroups.org/article/view/8700/html

  High risk patients who have a history of strictures, foreshortened colons, multiple pseudo polyps, family history of CRC, indeterminate or known dysplasia, or ongoing inflammation should undergo a more aggressive surveillance schedule. […] Individuals with ulcerative proctitis or proctosigmoiditis are not considered at increased risk for IBD related CRC and can have screening and surveillance intervals similar to the general population. […] It has been found that adherence to screening programs is usually low even in high-risk patients. […] Adherence was even worse in the high CRC risk groups. […] The rates at which individuals with IBD develop neoplasia from LGD vary significantly across different studies, with estimates ranging from 0% to 54%. […] The risk of progression to neoplasia also depends on many different variables as outlined elsewhere.

• #22

  https://journals.lww.com/ajg/fulltext/2024/10001/s1440_the_cecal_patch_in_ulcerative_proctitis___a.1441.aspx

  Of the 200 patients with isolated proctitis, 25 had a cecal patch present at index colonoscopy. […] In univariate analysis, the presence of a cecal patch was not significantly associated with proximal extension of disease (P =0.699). […] Patients with ulcerative proctitis had similar rates of proximal extension, medical therapy escalation or disease relapse regardless of the presence of a cecal patch. This suggests that a cecal patch does not confer increased risk of disease progression.

• #23 Radiation Proctitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/28181

  It is difficult to assess the true incidence of radiation proctitis. There are several large series that estimate chronic radiation proctitis to be anywhere between 5% to 11% of patients treated with radiation therapy. Almost 90% of patients who go on to experience chronic radiation proctitis will present in the first 2 years after treatment. […] The frequency of radiation proctitis exhibits variations across sexes and age groups, both in the United States and globally. While the prevalence rates can be influenced by the specific demographics of cancer incidence and treatment practices, some general patterns emerge. In the U.S., the occurrence of radiation proctitis is observed in both males and females undergoing pelvic radiation therapy for malignancies such as prostate, cervical, and rectal cancers. The incidence may differ based on the distribution of these cancers within each gender. Additionally, age plays a role, with older individuals more commonly affected due to the higher prevalence of cancer in this demographic.

• #24 Radiation Proctitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/28181

  Globally, the frequency of radiation proctitis is influenced by regional variations in cancer prevalence, treatment protocols, and healthcare infrastructure. In areas where pelvic malignancies are more prevalent or where radiation therapy is a common treatment modality, the incidence of radiation proctitis may be higher.

• #25 Proctitis Basics

  https://www.webmd.com/digestive-disorders/proctitis

  Proctitis is increasingly more common in homosexual men and in people engaging in oral-anal or anal intercourse with many partners. […] Prevention of proctitis begins with addressing any high-risk sexual behaviors that you may engage in. […] It is especially important to practice safe sex practices, such as using condoms, if you: Have or continue to have multiple sexual partners (or changing sexual partners) […] Because most cases of proctitis are caused by sexually transmitted infection, you may need antibiotics.

• #26

  http://www.bccdc.ca/health-info/diseases-conditions/proctitis

  It is important to not have sex (even with a condom) for a week after starting treatment. […] Your sexual partners within the last two months should be tested and treated for STIs. […] It is a good idea to be tested regularly for STIs, especially if you have new sexual partners or open relationships.

• #27 Proctitis

  https://www.eviq.org.au/Clinical-resources/Side-effect-and-toxicity-management/Gastrointestinal/421-Proctitis

  Attempts to use adjunctive medical therapy to prevent radiation proctitis have shown benefit in small trials, reducing symptoms of both acute and chronic radiation proctitis. […] The Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO) clinical practice guidelines for the management of mucositis secondary to cancer therapy recommend intravenous amifostine for preventing radiation proctitis. […] There are no comprehensive management guidelines and only limited evidence for the treatment of radiation proctitis. […] Many authors point out that large, prospective, randomised, controlled trials are needed to critically evaluate the available options.

• #28 Colorectal carcinoma surveillance | ECCO E-Guide

  https://www.e-guide.ecco-ibd.eu/interventions-investigational/colorectal-carcinoma-surveillance

  Longstanding colitis increases the risk of developing colon cancer. […] Population based studies have shown that this is less than previously thought, and mainly limited to sub-groups (e.g. onset before adulthood; duration 10y; concomitant PSC). […] Histologic or macroscopic pancolitis carries the highest risk, with no increased risk for patients with proctitis. […] Surveillance colonoscopies may detect CRC earlier, and although this may improve prognosis it has not been definitely proven to do so. […] In all patients with UC irrespective of the disease activity, a screening colonoscopy could be carried out 68 years after the beginning of symptoms in order to assess the patient’s individual risk profile. […] When disease activity is limited to the rectum without evidence of previous or current endoscopic and/or microscopic inflammation proximal to the rectum, inclusion in a regular surveillance colonoscopy programme is not necessary. […] Ongoing surveillance should be performed in all patients apart from those with proctitis.

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