Materiały źródłowe

• #1 Proctitis: What it is, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/5964-proctitis

  Proctitis can be chronic or acute, depending on the cause. Acute means sudden and temporary, while chronic disease lasts a long time. Different causes of proctitis produce different types that sometimes go by different names. For example, sexually-transmitted infections (STIs) can cause infectious proctitis, radiation therapy can cause radiation proctitis and ulcerative colitis can cause ulcerative proctitis. […] Treatment depends on the cause and how severe it is. It may include: Discontinuing whatever caused the inflammation. Antibiotics or antivirals to treat infections. Immunosuppressants for autoimmune-related proctitis. Sulfasalazine or mesalamine for ulcerative colitis/proctitis. Infliximab for Crohns-related proctitis. Topical corticosteroids for pain and inflammation. Sucralfate enemas to treat rectal ulcers. Endoscopic procedures to stop gastrointestinal bleeding.

• #1 Treatment for Proctitis – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/proctitis/treatment

  Your doctor will recommend treatments based on the type of proctitis you have and its cause. […] Doctors prescribe medicines to treat proctitis due to inflammatory bowel disease (IBD)ulcerative colitis or Crohns disease. […] Medicines to treat proctitis in IBD include aminosalicylates, corticosteroids, also called steroids, immunosuppressants, biologics. […] Doctors may recommend surgery to treat proctitis in IBD if medicines dont work or if you develop complications. […] Doctors typically prescribe medicines, such as antibiotics to treat bacterial infections or antiviral medicines to treat viral infections. […] Doctors treat radiation proctopathy based on how severe your symptoms are. […] If radiation proctopathy causes rectal bleeding that is severe or doesnt stop, doctors may use techniques during a lower endoscopy procedure to stop the bleeding.

• #1 Proctitis and Anusitis Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

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

  If the cause of proctitis is infectious, the treatment is targeted toward the pathogen responsible. […] Infectious proctitis due to Salmonella species is usually self-limited, and antibiotics are not required. Maintaining adequate fluid and electrolyte balances and providing supportive care are all that is required. […] Shigella proctitis is usually self-limited, but the duration may be shortened by the addition of antibiotics. An appropriate 1-week antibiotic course may include ampicillin, tetracycline, ciprofloxacin, or trimethoprim-sulfamethoxazole (preferred). […] Yersinia proctitis is also self-limited and should not be treated with antibiotics unless systemic bloodstream infection (BSI) occurs, in which case antibiotics (eg, trimethoprim-sulfamethoxazole, aminoglycosides, tetracycline, or a third-generation cephalosporin) should be given.

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

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

  Proctitis is inflammation of the rectum (i.e., the distal 1012 cm) that can be associated with anorectal pain, tenesmus, or rectal discharge. […] Acute proctitis among persons who have anal exposure through oral, genital, or digital contact is usually sexually acquired. Presumptive therapy should be initiated while awaiting results of laboratory tests for persons with anorectal exudate detected on examination or polymorphonuclear leukocytes detected on a Gram-stained smear of anorectal exudate or secretions. Such therapy also should be initiated when anoscopy or Gram stain is not available and the clinical presentation is consistent with acute proctitis for persons reporting receptive anal exposures. […] Recommended Regimen for Acute Proctitis: Ceftriaxone 500 mg* IM in a single dose PLUS Doxycycline 100 mg orally 2 times/day for 7 days.

• #1 Proctitis // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/proctitis

  Treatment for proctitis depends on the underlying cause of the inflammation. […] Your doctor may recommend medications to treat your infection. Options may include: […] For proctitis caused by bacterial infections, your doctor may recommend an antibiotic, such as doxycycline (Oracea, Vibramycin, others). […] For proctitis caused by viral infections, such as the sexually transmitted virus herpes, your doctor may prescribe an antiviral medication, such as acyclovir (Sitavig, Zovirax, others). […] Mild cases of radiation proctitis may not require treatment. In other cases, radiation proctitis can cause severe pain and bleeding that requires treatment. Your doctor may recommend treatments such as: […] Medications are given in pill, suppository or enema form. They include sucralfate (Carafate), mesalamine (Asacol HD, Canasa, others), sulfasalazine (Azulfidine) and metronidazole (Flagyl). These medications can help control inflammation and reduce bleeding.

• #1 Proctitis treatment guidelines – Melbourne Sexual Health Centre (MSHC)

  https://www.mshc.org.au/health-professionals/treatment-guidelines/proctitis-treatment-guidelines

  Proctitis likely to be sexually acquired […] Doxycycline 100mg PO, twice daily for 1 week […] AND […] Ceftriaxone 1g IM, stat […] AND consider […] Valaciclovir 500mg PO, twice daily for 7-10 days […] Treatment of suspected proctitis should be empirical and commenced prior to test results being available. If LGV is detected, extend doxycycline to 3 weeks. […] Treatment should take into account the clinical picture and epidemiology of STIs in the particular patient group. […] As it can be difficult to distinguish clinically between proctitis caused by chlamydia, gonorrhoea, and HSV, it is recommended that treatment of MSM with proctitis should cover all of these. […] Antiherpes treatment should be given with painful or ulcerative proctitis. […] For Mpox proctitis, refer to the Mpox treatment guidelines.

• #1 Proctitis // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/proctitis

  These techniques improve proctitis symptoms by destroying abnormal tissue (ablation) that is bleeding. Ablation procedures used to treat proctitis include argon plasma coagulation (APC), cryoablation, electrocoagulation and other therapies. […] Treatment of proctitis related to Crohn’s disease or ulcerative colitis is aimed at reducing the inflammation in your rectum. Treatment may include: […] Your doctor may prescribe anti-inflammatory medications, either by mouth or as a suppository or enema, such as mesalamine (Asacol HD, Canasa, others) or corticosteroids such as prednisone (Rayos) or budesonide (Entocort EC, Uceris). […] If drug therapy doesn’t relieve your signs and symptoms, your doctor may recommend surgery to remove a damaged portion of your digestive tract.

• #1 Proctitis and Anusitis Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

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

  Combination therapy using both oral agents and topical agents (eg, 5-ASA) has been shown to be more effective than therapy with either modality alone. In cases of refractory ulcerative proctitis, infliximab has been found to be effective in inducing a clinical response. […] Calcineurin inhibitors (eg, tacrolimus) have also been shown to be effective in treating refractory ulcerative colitis (UC) proctitis. […] Other less commonly used agents include tofacitinib, a Janus kinase (JAK) inhibitor that selectively targets JAK1 and JAK3 and has shown promising results, particularly in UC proctitis. […] Finally, on the basis of the theory that the appendix plays an immunomodulary role in UC, some studies have suggested performing appendectomy as an adjunct in the treatment of UC proctitis; there is evidence showing significant improvement of symptoms to the point where pharmacologic therapy can be discontinued.

• #1 Proctitis and Anusitis Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

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

  Finally, the indication for treatment of chronic radiation proctitis is also based on the symptomatology and grade of proctitis. Persistent rectal bleeding and diarrhea initiate a workup, including a rigid proctoscopy and/or colonoscopy. The presence of intractable bleeding despite multiple medical/endoscopic modalities, perforation, strictures, or fistulas is an indication for surgical intervention. […] In the course of any proctitis, antispasmodic agents may prove helpful in alleviating abdominal complaints. In addition, institution of a low-residue diet and the use of antidiarrheal agents and stool softeners are beneficial in view of the friability of the rectal mucosa and its vulnerability to damage from fecal contents. […] If proctitis is idiopathic or related to IBD, steroids, sulfasalazine, mesalamine, 5-aminosalicylic acid (5-ASA) products, and even immunosuppressive medications may be used. Many of these products are available as oral medications as well as enemas and suppositories.

• #1 Proctitis and Anusitis Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

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

  Vancomycin enemas may also be used in individuals in whom oral antibiotics may not reach a part of the colon (eg, those with a Hartmann pouch, ileostomy, or colonic diversion). […] Any other antibiotics should be discontinued if the clinical situation allows. […] Patients colonized with C difficile have a likelihood of recurrence; consequently, whenever they are placed on antibiotics, they should be aware of the possibility of diarrhea. In patients with recurrent C difficile infections, physicians may consider fecal microbiota transplantation, which has been reported to achieve cure rates of 90% and higher in multiple studies. […] Acute radiation proctitis is usually a self-limited condition, but supportive medical management (eg, hydration, antidiarrheals, and steroid or 5-ASA enemas) may be of benefit.

• #1 Proctitis

  https://www.eviq.org.au/clinical-resources/radiation-oncology/421-management-of-radiation-induced-proctitis

  Radiation proctitis is a term used to describe radiation-induced injury to the rectal mucosa following radiation therapy to the pelvic area. Depending on the time of onset, and to a lesser extent the clinical features and histology, radiation proctitis is defined as being either acute or chronic. […] Acute radiation proctitis is caused by direct radiation injury to the rectal mucosa, which results in inflammation with oedema, ulceration and shedding of the mucosa. […] Chronic radiation proctitis can present with a range of symptoms and these will determine the choice of management strategy. The level of intervention required will depend on the severity of symptoms and the risk-benefit profile of available treatment options. […] Patients with severe symptoms of acute radiation proctitis may need to have their radiation therapy suspended for a short period. Otherwise, treatment is of a supportive nature including maintaining adequate hydration, dietary changes, antidiarrhoeal medication as required, analgesics if pain is a problem, antispasmodics for tenesmus, topical analgesia for anal soreness, oral/rectal steroids and/or butyrate enemas may be considered. […] When conservative treatments for chronic radiation proctitis have been unsuccessful, interventional treatments such as endoscopic argon plasma coagulation (AOC), hyperbaric oxygen, or surgery may be appropriate treatment options.

• #1 Proctitis and Anusitis Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

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

  Chronic radiation proctitis involves more extensive medical treatment, including both oral and rectal therapies. Oral medications include 5-ASA, sulfasalazine, steroids, and metronidazole. […] In cases of hemorrhagic proctitis, the use of WF10, an IV therapy initially developed as an adjunctive AIDS treatment, has been shown to be effective. […] Initial studies demonstrated control of bleeding within two doses of therapy and maintenance of results with once- to twice-yearly repeat therapy. […] Rectal therapy for chronic radiation proctitis with sucralfate or pentosan polysulfate has been shown to result in better symptomatic relief than oral anti-inflammatory therapy. […] Studies have found sucralfate enemas to be the most effective medical therapy for radiation proctitis when they are administered twice daily for 3 months.

• #1 Proctitis and Anusitis Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

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

  A large single-center study reported a 63% response rate in patients with gastrointestinal (GI) radionecrosis, supporting the findings of several previous smaller series. […] HBO has emerged as a potential therapy for radiation proctitis because of its ability to increase the number of blood vessels in irradiated tissues by acting as a stimulant for angiogenesis. […] HBO is not widely available, because of high costs and the need for specialized equipment, but it has been recommended by the ASCRS for treatment of chronic radiation proctitis and is considered effective. […] Other medical therapies aimed at the treatment of radiation proctitis (eg, antioxidant therapy with vitamins A, C, and E) have shown efficacy in small single-institution studies. […] A study by Wu et al showed significantly improved outcomes with high-dose vitamin C when it was combined with traditional drugs such as cyclooxygenase (COX)-2 inhibitors, though this study was limited by the small sample size.

• #1 Proctitis and Anusitis Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

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

  Ileostomy or reconstruction with an ileal pouch may be offered after total proctocolectomy. […] In patients with severe Crohn disease (CD) colitis or proctitis, options range from fecal diversion to proctectomy to total proctocolectomy, depending on the extent of the disease process. […] In the infectious causes of proctitis, surgical treatment is rarely required. In cases of severe C difficile colitis, a subtotal colectomy may be warranted. […] For patients with radiation proctitis complicated by refractory bleeding, endoscopic therapy seems to be more effective than medical therapy; it also results in less morbidity. […] Specifically, argon plasma coagulation (APC) may be superior to formalin and endoscopic laser treatments, though some studies have reported similar outcomes when comparing APC with formalin.

• #1 Proctitis and Anusitis Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

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

  Other endoscopic therapies include endoscopic thermal methods, such as heater probes and lasers, which destroy telangiectasias to stop bleeding. […] If, despite medical and endoscopic measures, significant hemorrhage still occurs, a laparoscopic fecal diversion (ileostomy or colostomy) should be performed. […] Although fecal diversion alleviates patients’ symptoms, it rarely eliminates them entirely; it should be reserved for truly refractory cases. […] Fewer than 10% of patients do not respond to some form of medical management and require surgical intervention. […] Rarely, radiation proctitis can be so severe that it ulcerates, potentially leading to the formation of a rectourethral fistula. In these cases, temporary fecal and urinary diversion should be performed until the inflammation subsides. […] Definitive therapy may then be provided. The procedure of choice is a perineal approach with repair of the defect with muscle and mucosal flaps.

• #1 Treatment for Proctitis – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/proctitis/treatment

  Doctors may recommend surgery to treat radiation proctopathy if other treatments dont work or if you develop complications. […] If you develop diversion proctitis after ostomy surgery of the bowel, doctors may recommend surgery to close the ostomy and reconnect your rectum to the rest of your intestines. […] If you cannot have surgery to reconnect your rectum to the rest of your intestines, your doctor may recommend medicines to treat diversion proctitis, including medicines you insert into your rectum such as suppositories and enemas. […] Doctors may recommend treating the causes of other types of proctitis. […] Doctors may also recommend medicines to help reduce proctitis symptoms. […] Doctors may recommend surgery to treat complications of proctitis, such as abscesses, fistulas, or strictures. […] Doctors may also recommend surgery to treat proctitis if other treatments dont work. […] You can lower your risk for infectious proctitis by taking steps to prevent sexually transmitted infections and food poisoning. […] However, experts havent found ways to prevent other types of proctitis.

• #1 Proctitis and Anusitis Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

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

  Additionally, ozone therapy via rectal insufflation and topical ozonized oil have shown some promise, but large randomized clinical trials are lacking. […] More invasive management of radiation proctitis with rectal/topical formalin is believed to work via sclerosis of neovasculature in a form of chemical cauterization. […] Multiple studies have demonstrated the efficacy of formalin in the resolution of hemorrhagic proctitis, with success rates in the range of 70-80%. […] Significant complications from treatment include stricture and damage to the perianal skin. […] Symptomatic diversion proctitis generally improves after the ostomy is taken down and bowel continuity is restored. However, in patients who need to be out of circuit indefinitely, SCFA enemas may be beneficial. […] For patients with UC who require surgical therapy, a total proctocolectomy should be performed because of the risk of cancer in the remaining rectal stump.

• #1 Radiation Proctitis: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/radiation-proctitis

  A healthcare provider may recommend changes to your eating patterns to reduce any gastrointestinal symptoms that can further irritate inflamed tissue. They may recommend: Cutting back on dairy products, including milk, cheese, butter and yogurt, Restricting foods high in saturated fats, including eggs, high-fat meats (fatty cuts of beef and pork and poultry with skin) and oils (coconut oil, palm oil and palm kernel oil), Eating more high-fiber foods, including fruit, vegetables, beans, lentils, seeds and nuts.

• #1 Proctitis: What it is, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/5964-proctitis

  Most cases of proctitis respond well to treatment. If its an acute case, it should resolve within four to eight weeks for adults or months for infants. If you have chronic proctitis associated with IBD, you may notice the inflammation comes and goes. You can treat flare-ups with anti-inflammatory drugs as needed. A small percentage of people develop chronic radiation proctitis that persists for a long time. Chronic cases are more likely to involve complications, which may be trickier to treat.

• #1 Proctitis Symptoms, Treatment, Causes & Definition

  https://www.emedicinehealth.com/proctitis/article_em.htm

  Proctitis Follow-up […] Follow-up is an integral part of treating proctitis. […] You must finish all the antibiotics given you. […] You should abstain from any sexual practice that may irritate the disease. […] Follow up with a visit to your health care provider after 1-2 weeks to determine whether the inflammation has cleared or if you should continue therapy. […] At any point, if the symptoms get worse, either contact your doctor or go to the emergency department, depending on the severity of your symptoms.

• #1 Proctitis Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/proctitis

  Most of the time, proctitis will go away when the cause of the problem is treated. Antibiotics are used if an infection is causing the problem. […] Corticosteroids or mesalamine suppositories or enemas may relieve symptoms for some people. […] The outcome is good with treatment.

• #2 Proctitis – Symptoms & causes – Mayo Clinic

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

  Proctitis is inflammation of the lining of the rectum. Proctitis can cause rectal pain, diarrhea, bleeding and discharge, as well as the continuous feeling that you need to have a bowel movement. […] Make an appointment with your doctor if you have any signs or symptoms of proctitis. […] Proctitis that isn’t treated or that doesn’t respond to treatment may lead to complications, including: […] To reduce your risk of proctitis, take steps to protect yourself from sexually transmitted infections (STIs).

• #2 Proctitis: What it is, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/5964-proctitis

  Proctitis can be chronic or acute, depending on the cause. Acute means sudden and temporary, while chronic disease lasts a long time. Different causes of proctitis produce different types that sometimes go by different names. For example, sexually-transmitted infections (STIs) can cause infectious proctitis, radiation therapy can cause radiation proctitis and ulcerative colitis can cause ulcerative proctitis. […] Treatment depends on the cause and how severe it is. It may include: Discontinuing whatever caused the inflammation. Antibiotics or antivirals to treat infections. Immunosuppressants for autoimmune-related proctitis. Sulfasalazine or mesalamine for ulcerative colitis/proctitis. Infliximab for Crohns-related proctitis. Topical corticosteroids for pain and inflammation. Sucralfate enemas to treat rectal ulcers. Endoscopic procedures to stop gastrointestinal bleeding.

• #2 Proctitis // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/proctitis

  Treatment for proctitis depends on the underlying cause of the inflammation. […] Your doctor may recommend medications to treat your infection. Options may include: […] For proctitis caused by bacterial infections, your doctor may recommend an antibiotic, such as doxycycline (Oracea, Vibramycin, others). […] For proctitis caused by viral infections, such as the sexually transmitted virus herpes, your doctor may prescribe an antiviral medication, such as acyclovir (Sitavig, Zovirax, others). […] Mild cases of radiation proctitis may not require treatment. In other cases, radiation proctitis can cause severe pain and bleeding that requires treatment. Your doctor may recommend treatments such as: […] Medications are given in pill, suppository or enema form. They include sucralfate (Carafate), mesalamine (Asacol HD, Canasa, others), sulfasalazine (Azulfidine) and metronidazole (Flagyl). These medications can help control inflammation and reduce bleeding.

• #2 Proctitis and Anusitis Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

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

  Campylobacter proctitis is usually self-limited as well. […] E histolytica proctitis generally is treated with metronidazole or tinidazole followed by an intraluminal agent such as paromomycin, diloxanide furoate, clioquinol, or iodoquinol. […] Sexually transmitted proctitis requires treatment similar to the corresponding treatment for a genital infection. In patients with mild symptoms, empiric treatment should ideally be avoided to reduce the risk of antibiotic resistance. Once the pathogen is determined, specific therapy should be initiated. […] C difficile infection generally is treated with intravenous (IV) or oral metronidazole or oral vancomycin. […] A more aggressive C difficile mutation has been observed that may have a rapidly progressive course toward BSI and toxic colitis. In patients who do not appear to be responding to metronidazole and who have leukocytosis (leukocyte count 20,000/L), therapy should be switched to oral vancomycin.

• #2 Acute Proctitis Treatment & Management: Emergency Department Care, Consultations

  https://emedicine.medscape.com/article/775952-treatment

  Treatment depends upon the etiology, including the following: […] Steroid enemas or suppositories for ulcerative proctitis canasa 1 g enema or suppository daily for a month […] Ceftriaxone and doxycycline for gonorrheal proctitis […] Acyclovir for herpetic proctitis […] Tetracycline or doxycycline for chlamydial proctitis […] Shigella proctitis is usually self-limiting but may require, under certain circumstances, prolonged (2-4 wk) antibiotic treatment with ampicillin, tetracycline, ciprofloxacin, or trimethoprim and sulfamethoxazole (TMP-SMZ) […] Yersinia proctitis is usually self-limiting, but, if systemic bacteremia occurs, treat with intravenous antibiotics such as tetracycline or ceftriaxone […] Campylobacter proctitis is a self-limiting disease; treatment is aimed at symptomatic relief

• #2 Treatment for Proctitis – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/proctitis/treatment

  Your doctor will recommend treatments based on the type of proctitis you have and its cause. […] Doctors prescribe medicines to treat proctitis due to inflammatory bowel disease (IBD)ulcerative colitis or Crohns disease. […] Medicines to treat proctitis in IBD include aminosalicylates, corticosteroids, also called steroids, immunosuppressants, biologics. […] Doctors may recommend surgery to treat proctitis in IBD if medicines dont work or if you develop complications. […] Doctors typically prescribe medicines, such as antibiotics to treat bacterial infections or antiviral medicines to treat viral infections. […] Doctors treat radiation proctopathy based on how severe your symptoms are. […] If radiation proctopathy causes rectal bleeding that is severe or doesnt stop, doctors may use techniques during a lower endoscopy procedure to stop the bleeding.

• #2 Management of Patients With Refractory Ulcerative Proctitis – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/february-2025/management-of-patients-with-refractory-ulcerative-proctitis/

  Ulcerative proctitis is part of the disease spectrum of ulcerative colitis. […] Conventionally, it was defined based on failure of topical therapy. […] The local concentration achieved with topical therapy likely exceeds the concentration obtained with some of the common oral therapies, and that applies to any form of ulcerative colitis. […] In patients with ulcerative proctitis that does not respond to topical mesalamine or corticosteroids, 2 relatively small clinical trials with another topical therapy called tacrolimus offered a new option. […] The only one that has been studied in a clinical trial thus far is the sphingosine-1 phosphate (S1P) receptor modulator etrasimod (Velsipity, Pfizer) in the ELEVATE trial. […] That idea comes from a small trial from Australia of patients who had relatively refractory ulcerative proctitis, with 10% not responding to or having inadequate response to biologics.

• #2 Proctitis and Anusitis Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

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

  Ileostomy or reconstruction with an ileal pouch may be offered after total proctocolectomy. […] In patients with severe Crohn disease (CD) colitis or proctitis, options range from fecal diversion to proctectomy to total proctocolectomy, depending on the extent of the disease process. […] In the infectious causes of proctitis, surgical treatment is rarely required. In cases of severe C difficile colitis, a subtotal colectomy may be warranted. […] For patients with radiation proctitis complicated by refractory bleeding, endoscopic therapy seems to be more effective than medical therapy; it also results in less morbidity. […] Specifically, argon plasma coagulation (APC) may be superior to formalin and endoscopic laser treatments, though some studies have reported similar outcomes when comparing APC with formalin.

• #2 Radiation Proctitis: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/radiation-proctitis

  Radiation proctitis is inflammation in your rectum that develops after radiation therapy. Symptoms generally affect your bathroom habits, including diarrhea, sudden urges to poop and rectal bleeding. But they can be more severe and last a long time. Medications can treat mild cases. But more serious cases may include different therapies or surgery. […] For more severe radiation proctitis, a healthcare provider may recommend: Enema with sucralfate, Applying a low concentration of formaldehyde (formalin) to your affected areas, Inserting a type of corticosteroid (glucocorticoid) into your rectum (rectal suppository), Argon plasma coagulation, Hyperbaric oxygen therapy, Surgically changing the way poop exits your body (ileostomy or colostomy), Surgically removing the affected areas. […] Healthcare providers try to minimize or prevent radiation proctitis by using modern radiation therapy techniques, such as image-guided radiation therapy and intensity-modulated radiation therapy. These techniques destroy cancer cells while minimizing radiation exposure to your rectal tissue and other tissues in the surrounding area.

• #2 Proctitis

  https://www.eviq.org.au/clinical-resources/radiation-oncology/421-management-of-radiation-induced-proctitis

  Radiation proctitis is a term used to describe radiation-induced injury to the rectal mucosa following radiation therapy to the pelvic area. Depending on the time of onset, and to a lesser extent the clinical features and histology, radiation proctitis is defined as being either acute or chronic. […] Acute radiation proctitis is caused by direct radiation injury to the rectal mucosa, which results in inflammation with oedema, ulceration and shedding of the mucosa. […] Chronic radiation proctitis can present with a range of symptoms and these will determine the choice of management strategy. The level of intervention required will depend on the severity of symptoms and the risk-benefit profile of available treatment options. […] Patients with severe symptoms of acute radiation proctitis may need to have their radiation therapy suspended for a short period. Otherwise, treatment is of a supportive nature including maintaining adequate hydration, dietary changes, antidiarrhoeal medication as required, analgesics if pain is a problem, antispasmodics for tenesmus, topical analgesia for anal soreness, oral/rectal steroids and/or butyrate enemas may be considered. […] When conservative treatments for chronic radiation proctitis have been unsuccessful, interventional treatments such as endoscopic argon plasma coagulation (AOC), hyperbaric oxygen, or surgery may be appropriate treatment options.

• #2 Proctitis and Anusitis Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

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

  Such rectal therapies are believed to work via stimulation of epithelial healing and formation of a protective barrier. […] Steroid and short-chain fatty acid (SCFA) enemas have been used with moderate success. […] When given in enemas, hydrocortisone seems to relieve symptoms and rectal bleeding more effectively than other steroids (eg, betamethasone). […] Whereas SCFA enemas (eg, butyrate) have some proven benefit in other types of proctitis, they have not been conclusively demonstrated to have any beneficial effect on proctitis secondary to radiation. […] In fact, American Society of Colon and Rectal Surgeons (ASCRS) guidelines have stated that SCFAs are not recommended in the treatment of chronic hemorrhagic proctitis. […] Hyperbaric oxygen (HBO) has been shown to have some efficacy in the treatment of radiation-induced proctitis.

• #2 Proctitis and Anusitis Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

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

  Additionally, ozone therapy via rectal insufflation and topical ozonized oil have shown some promise, but large randomized clinical trials are lacking. […] More invasive management of radiation proctitis with rectal/topical formalin is believed to work via sclerosis of neovasculature in a form of chemical cauterization. […] Multiple studies have demonstrated the efficacy of formalin in the resolution of hemorrhagic proctitis, with success rates in the range of 70-80%. […] Significant complications from treatment include stricture and damage to the perianal skin. […] Symptomatic diversion proctitis generally improves after the ostomy is taken down and bowel continuity is restored. However, in patients who need to be out of circuit indefinitely, SCFA enemas may be beneficial. […] For patients with UC who require surgical therapy, a total proctocolectomy should be performed because of the risk of cancer in the remaining rectal stump.

• #2 Proctitis and Anusitis Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

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

  Other endoscopic therapies include endoscopic thermal methods, such as heater probes and lasers, which destroy telangiectasias to stop bleeding. […] If, despite medical and endoscopic measures, significant hemorrhage still occurs, a laparoscopic fecal diversion (ileostomy or colostomy) should be performed. […] Although fecal diversion alleviates patients’ symptoms, it rarely eliminates them entirely; it should be reserved for truly refractory cases. […] Fewer than 10% of patients do not respond to some form of medical management and require surgical intervention. […] Rarely, radiation proctitis can be so severe that it ulcerates, potentially leading to the formation of a rectourethral fistula. In these cases, temporary fecal and urinary diversion should be performed until the inflammation subsides. […] Definitive therapy may then be provided. The procedure of choice is a perineal approach with repair of the defect with muscle and mucosal flaps.

• #2 Radiation Proctitis: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/radiation-proctitis

  A healthcare provider may recommend changes to your eating patterns to reduce any gastrointestinal symptoms that can further irritate inflamed tissue. They may recommend: Cutting back on dairy products, including milk, cheese, butter and yogurt, Restricting foods high in saturated fats, including eggs, high-fat meats (fatty cuts of beef and pork and poultry with skin) and oils (coconut oil, palm oil and palm kernel oil), Eating more high-fiber foods, including fruit, vegetables, beans, lentils, seeds and nuts.

• #2 Proctitis – Shore Gastroenterology Associates

  https://shoregastro.com/conditions-and-diseases/proctitis/

  Radiation proctitis can be a bit more challenging and may be treated with thermal therapy using sigmoidoscopy or corticosteroid enemas. Those who have proctitis from IBD will likely be prescribed anti-inflammatory drugs as well as corticosteroids to also help manage IBD symptoms, especially during flare-ups. Infliximab is another medication used to help manage IBD symptoms. […] Your healthcare provider might also suggest avoiding caffeine, greasy foods, and high-fiber foods either during the course of treatment or as a permanent change as a preventative measure.

• #2 Proctitis: Causes, Treatment, and Surgery

  https://www.bezzyibd.com/discover/managing-ibd/health-what-is-proctitis/

  You may eventually need surgery if you have ulcerative colitis or Crohns disease and frequent cases of proctitis. Ulcerative colitis and Crohns disease are two autoimmune diseases that affect your digestive tract. […] Many cases of proctitis are treated successfully with medication and lifestyle changes. In rare cases, proctitis can lead to complications. Possible complications include: ulcers, open sores that develop in the rectum and colon; abscesses, pus-filled areas of infection; anemia, a deficiency of red blood cells caused by rectal bleeding.

• #2 Proctitis: What it is, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/5964-proctitis

  Most cases of proctitis respond well to treatment. If its an acute case, it should resolve within four to eight weeks for adults or months for infants. If you have chronic proctitis associated with IBD, you may notice the inflammation comes and goes. You can treat flare-ups with anti-inflammatory drugs as needed. A small percentage of people develop chronic radiation proctitis that persists for a long time. Chronic cases are more likely to involve complications, which may be trickier to treat.

• #3 Proctitis // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/proctitis

  Treatment for proctitis depends on the underlying cause of the inflammation. […] Your doctor may recommend medications to treat your infection. Options may include: […] For proctitis caused by bacterial infections, your doctor may recommend an antibiotic, such as doxycycline (Oracea, Vibramycin, others). […] For proctitis caused by viral infections, such as the sexually transmitted virus herpes, your doctor may prescribe an antiviral medication, such as acyclovir (Sitavig, Zovirax, others). […] Mild cases of radiation proctitis may not require treatment. In other cases, radiation proctitis can cause severe pain and bleeding that requires treatment. Your doctor may recommend treatments such as: […] Medications are given in pill, suppository or enema form. They include sucralfate (Carafate), mesalamine (Asacol HD, Canasa, others), sulfasalazine (Azulfidine) and metronidazole (Flagyl). These medications can help control inflammation and reduce bleeding.

• #3 Proctitis and Anusitis Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

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

  Finally, the indication for treatment of chronic radiation proctitis is also based on the symptomatology and grade of proctitis. Persistent rectal bleeding and diarrhea initiate a workup, including a rigid proctoscopy and/or colonoscopy. The presence of intractable bleeding despite multiple medical/endoscopic modalities, perforation, strictures, or fistulas is an indication for surgical intervention. […] In the course of any proctitis, antispasmodic agents may prove helpful in alleviating abdominal complaints. In addition, institution of a low-residue diet and the use of antidiarrheal agents and stool softeners are beneficial in view of the friability of the rectal mucosa and its vulnerability to damage from fecal contents. […] If proctitis is idiopathic or related to IBD, steroids, sulfasalazine, mesalamine, 5-aminosalicylic acid (5-ASA) products, and even immunosuppressive medications may be used. Many of these products are available as oral medications as well as enemas and suppositories.

• #3

  https://www.everlywell.com/blog/virtual-care/proctitis-treatment/?srsltid=AfmBOopWM5X3HP3NgX5c4tZOYvJH51hy9ujFz18LMGrWlmkNvVK5x5sv

  Treatment of proctitis related to Crohn’s disease or ulcerative colitis is aimed at reducing the inflammation in your rectum. Treatment may include: Medications to control rectal inflammation. Your doctor may prescribe anti-inflammatory medications, either by mouth or as a suppository or enema, such as mesalamine or corticosteroids. Inflammation in people with Crohn’s disease often requires treatment with a medication that suppresses the immune system, such as azathioprine or infliximab. Surgery. If drug therapy doesn’t relieve your signs and symptoms, your doctor may recommend surgery to remove a damaged portion of your digestive tract.

• #3 Radiation Proctitis: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/radiation-proctitis

  Radiation proctitis is inflammation in your rectum that develops after radiation therapy. Symptoms generally affect your bathroom habits, including diarrhea, sudden urges to poop and rectal bleeding. But they can be more severe and last a long time. Medications can treat mild cases. But more serious cases may include different therapies or surgery. […] For more severe radiation proctitis, a healthcare provider may recommend: Enema with sucralfate, Applying a low concentration of formaldehyde (formalin) to your affected areas, Inserting a type of corticosteroid (glucocorticoid) into your rectum (rectal suppository), Argon plasma coagulation, Hyperbaric oxygen therapy, Surgically changing the way poop exits your body (ileostomy or colostomy), Surgically removing the affected areas. […] Healthcare providers try to minimize or prevent radiation proctitis by using modern radiation therapy techniques, such as image-guided radiation therapy and intensity-modulated radiation therapy. These techniques destroy cancer cells while minimizing radiation exposure to your rectal tissue and other tissues in the surrounding area.

• #3 Proctitis – Shore Gastroenterology Associates

  https://shoregastro.com/conditions-and-diseases/proctitis/

  Radiation proctitis can be a bit more challenging and may be treated with thermal therapy using sigmoidoscopy or corticosteroid enemas. Those who have proctitis from IBD will likely be prescribed anti-inflammatory drugs as well as corticosteroids to also help manage IBD symptoms, especially during flare-ups. Infliximab is another medication used to help manage IBD symptoms. […] Your healthcare provider might also suggest avoiding caffeine, greasy foods, and high-fiber foods either during the course of treatment or as a permanent change as a preventative measure.

• #3 Proctitis: Symptoms, Causes, Treatment, and Outlook

  https://resources.healthgrades.com/right-care/digestive-health/proctitis

  Natural remedies that a doctor might recommend can include: cutting back on spicy, acidic, and fatty foods, drinking plenty of fluids, avoiding caffeine, discussing safe sex methods with a clinician, avoiding alcohol fructose, avoiding dairy products, such as ice cream, eating more foods that are rich in vitamin C and E, and getting more omega-3 fatty acids by eating foods such as salmon, nuts, and seeds. […] Many types of proctitis are treatable. […] Treatments focus on addressing the underlying cause, and the options include immunosuppressants, corticosteroids, and antibiotics. The doctor may also recommend home remedies, such as sitz baths and drinking plenty of fluids. […] Anyone experiencing the symptoms of proctitis should seek a diagnosis and treatment.

• #4 Treatment of Chronic Radiation Proctitis (2018) | ASCRS Toolkit – FREE Resources

  https://www.ascrsu.com/ascrs/view/ASCRS-Toolkit/2851049/all/Treatment_of_Chronic_Radiation_Proctitis

  1. A disease-specific history and physical examination should be performed, emphasizing the degree and duration of bleeding. Grade of Recommendation: Strong recommendation based on low-quality evidence, 1C. […] The typical patient with chronic radiation proctitis (CRP) will present with hematochezia. Other common symptoms are fecal urgency, tenesmus, or drainage of mucus from the rectum. […] Prophylactic measures, such as pedicled omental flap and tissue expander implant, have been described to decrease the incidence of radiation proctitis. These techniques are insufficiently evaluated and are not routinely recommended. Grade of Recommendation: Strong recommendation based on low-quality evidence, 1C. […] 1. Formalin application is an effective treatment for bleeding in patients with CRP. Grade of Recommendation: Strong recommendation based on moderate-quality evidence, 1B. […] Formalin (ie, formaldehyde 4%10%) has been used for 2 decades for the treatment of patients with CRP. […] Sucralfate retention enemas are a moderately effective treatment for rectal bleeding resulting from CRP. Grade of Recommendation: Strong recommendation based on low-quality evidence, 1C. […] Short chain fatty acid enemas are not effective in preventing or treating chronic hemorrhagic radiation proctitis and are not recommended. Grade of Recommendation: Weak recommendation based on moderate-quality evidence, 1B. […] Alternative treatments such as mesalamine, ozone therapy, and metronidazole have not been adequately evaluated in treating radiation proctitis and are not recommended. Grade of Recommendation: Strong recommendation based on low-quality evidence, 1C.

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