Materiały źródłowe

• #1 Proctitis and Anusitis – StatPearls – NCBI Bookshelf

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

  Proctitis is inflammation of the rectal mucosa, distal to the rectosigmoid junction, within 18 cm of the anal verge. […] Proctitis and anusitis may happen secondary to ulcerative colitis (UC), Chronic Radiation Proctitis, Proctopathy (CRP), or Diversion Proctitis (DP). Infectious causes include Clostridium difficile, enteric infections (Campylobacter, Shigella, Escherichia coli, Salmonella, and amebiasis), and STIs (Gonorrhea, Chlamydia, Syphilis, HSV, Lymphogranuloma venereum, chancroid, CMV, HPV). […] In genetically predisposed individuals with dysregulated immune responses, GI infections may increase the risk of ulcerative proctitis (UP). Appendectomy and smoking appeared to act as protective factors from UP. CRP occurs secondary to ischemic and fibrotic changes. In the case of DP, proximal fecal diversion causes increased nitrate-reducing bacteria and decreased obligate anaerobes resulting in short-chain fatty acids deficiency. Rectal intercourse in women or MSM can result in proctocolitis. Radiation injury occurs with doses 8 Gy or higher causing damage to intestinal cell DNA with helical breaks and inability to replicate and undergo normal cellular repair.

• #1 Acute Proctitis: Background, Pathophysiology, Etiology

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

  Proctitis involves mucosal cell loss, acute inflammation of the lamina propria, eosinophilic crypt abscess, and endothelial edema of the arterioles. […] These may improve or in turn progress with subsequent fibrosis of connective tissue and endarteritis of the arterioles, resulting in rectal tissue ischemia and leading to mucosal friability, bleeding, ulcers, strictures, and fistula formation.

• #1 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 is common in people who have inflammatory bowel disease (Crohn’s disease or ulcerative colitis). […] Several diseases and conditions can cause inflammation of the rectal lining. […] About 30% of people with inflammatory bowel disease (Crohn’s disease or ulcerative colitis) have inflammation of the rectum. […] Sexually transmitted infections, spread particularly by people who engage in anal intercourse, can result in proctitis. […] Radiation therapy directed at your rectum or nearby areas, such as the prostate, can cause rectal inflammation. […] Sometimes antibiotics used to treat an infection can kill helpful bacteria in the bowels, allowing the harmful Clostridium difficile bacteria to grow in the rectum. […] Proctitis can occur in people following some types of colon surgery in which the passage of stool is diverted from the rectum to a surgically created opening (stoma). […] This condition occurs when a type of white blood cell (eosinophil) builds up in the lining of the rectum.

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

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

  Proctitis is defined as inflammation of the rectal mucosa, distal to the rectosigmoid junction and within 20 cm of the anal verge. The two most common causes of patients presenting with proctitis are infective causes and inflammatory bowel disease (IBD). […] Infective proctitis is usually caused by sexually transmitted infections. […] The pathogenesis and pathophysiology are incompletely understood but are thought to involve a complex interplay between environmental factors, immune dysregulation, dysbiosis, and genetic predisposition. […] 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.

• #1 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; they have the same pathogenetic mechanism and the same immunologic background. […] Furthermore, mechanistically the underlying process that leads to disease development is the same, an overactive immune response against something within the colon and likely a loss of tolerance toward bacteria living inside the colon. […] The results for etrasimod in the ulcerative proctitis group were at least as good as those for patients with more extensive ulcerative colitis. […] The evidence from retrospective analyses is weakened by biases and limitations, but it does suggest that biologics and other small molecules such as tofacitinib are also effective for ulcerative proctitis. […] This is probably the largest knowledge gap, knowing whether treating patients with ulcerative proctitis to the target of endoscopic or histologic remission truly prevents disease extension, which otherwise occurs in 30% to 40% of these patients.

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

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

  Radiation proctitis is inflammation of the rectum that occurs as a result of acute damage to the rectum sustained from pelvic radiation. […] 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). […] 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.

• #1 Radiation Proctitis and Management Strategies

  https://www.e-ce.org/journal/view.php?number=7593

  The pathogenesis of RP is complex and yet to be fully understood. […] The damage to tissues secondary to RT is widespread; however, in essence, both direct and indirect mechanisms of tissue damage via radiation target cellular deoxyribonucleic acid (DNA), thereby inhibiting transcription and preventing cellular replication. […] Through the direct mechanism, ionizing radiation directly damages the DNA or cell membrane. […] The indirect mechanism involves the generation of free radicals from the ionization of water molecules, leading to oxidative stress injuries. […] Damage to the rapidly dividing intestinal crypt stem cells in the radiation field leads to their depletion, resulting in crypt involution, mucosal injury, and exposure of the underlying lamina propria to luminal bacteria.

• #1 Radiation proctitis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Radiation_proctitis_pathophysiology

  The exact pathogenesis of radiation proctitis is not fully understood however it is thought that acute radiation proctitis is due to direct damage of the lining (epithelium) of the colon. Chronic radiation proctitis occurs in part because of damage to the blood vessels which supply the colon and results in full-thickness ischemia and fibrotic changes and ultimately the colon is therefore deprived of oxygen and necessary nutrients. […] Acute radiation proctitis is due to direct damage of the lining (epithelium) of the colon. […] Chronic radiation proctitis occurs in part because of damage to the blood vessels which supply the colon and results in full-thickness ischemia and fibrotic changes and ultimately the colon is therefore deprived of oxygen and necessary nutrients. […] Ionizing radiation primarily damages DNA leading to the apoptosis of targeted tumor cells, however inadvertently intestinal crypt stem cells in the radiation field get also affected resulting in crypt involution, mucosal injury, and exposure of the underlying lamina propria to luminal bacteria and activation of acute inflammatory response.

• #1 KoreaMed Synapse

  https://synapse.koreamed.org/articles/1516078407

  The pathogenesis of RP is complex and yet to be fully understood. To better comprehend the pathogenic process, it is divided into two sections. […] It is essential to first understand the mechanism by which ionizing radiation causes damage to tissues at the cellular level. The damage to tissues secondary to RT is widespread; however, in essence, both direct and indirect mechanisms of tissue damage via radiation target cellular deoxyribonucleic acid (DNA), thereby inhibiting transcription and preventing cellular replication. […] The mucosa of the GI tract is highly proliferative. As per the literature, enterocytes have the highest turnover rate of any fixed cell in the body. Hence, the rapidly dividing mucosal stem cells present within the crypts of Lieberkhn are highly susceptible to radiation injury. Initiation of RP occurs via radiation-induced damage to the mucosa, followed by late indolent connective tissue growth and remodeling, and subsequently tissue response to the ongoing ischemia. […] Additionally, radiation can directly damage the vascular and endothelial cells leading to full-thickness bowel ischemia; hence, it plays a major role in the pathogenesis of RP.

• #1 Proctitis

  https://www.eviq.org.au/Clinical-resources/Side-effect-and-toxicity-management/Gastrointestinal/421-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 is related to late effects of radiation damage. Injury to small blood vessels causes progressive ischaemic changes and atrophy of the rectal mucosa. This is followed by ulceration, fibrosis and telangiectasia development. In severe cases, strictures and fistulae may result. […] There is also evidence that the occurrence and/or severity of acute radiation proctitis may be predictive of the development of chronic radiation proctitis. This correlation may have implications for future preventative strategies and interventions.

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

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

  There are many overlapping features between infective and inflammatory proctitis, and, consequently, a high index of suspicion is required. […] Endoscopic and histological appearances in infective proctitis can appear indistinguishable from IBD. […] However, in several misdiagnosed cases, lesions and inflammation were often identified as “non-specific” or “atypical”, suggesting a degree of doubt. […] The absence of crypt architectural distortion has previously been identified as a significant distinguishing feature, alongside raised Paneth cells and increased eosinophil levels, both of which are more common in IBD. […] Histological features, which favour IBD over infective causes, take several weeks to be present, and, therefore, in an acute presentation, may be absent.

• #1 What Is CMV Proctitis and How Is It Managed?

  https://www.icliniq.com/articles/immune-disorders/cytomegalovirus-proctitis

  CMV proctitis, a severe manifestation in immunocompromised individuals, involves inflammation of the rectum caused by cytomegalovirus reactivation. […] However, the dormant CMV can reactivate and cause illness in specific circumstances where a person’s immune system is compromised or inhibited. […] When CMV reactivates in a person with a weakened immune system, it can cause inflammation and infection in various parts of the body. CMV proctitis, or inflammation of the rectum (the last segment of the large intestine) brought on by the reactivated CMV virus, is one such severe symptom. […] Immunosuppression is the main risk factor for CMV proctitis development. […] CMV proctitis is a serious condition affecting immunocompromised individuals caused by the reactivation of the cytomegalovirus. Effective care requires early diagnosis by endoscopy and laboratory tests, rapid beginning of antiviral therapy, and early detection. Preventive interventions are essential in lowering the incidence and complications of CMV proctitis.

• #1 Allergic proctitis, a clinical and immunopathological entity. | Gut

  https://gut.bmj.com/content/21/12/1017

  Patients with isolated ulcerative proctitis form a heterogeneous group. […] However, in contrast with proctitis on the base of ulcerative colitis or Crohn’s disease, immunoperoxidase staining revealed a markedly increased number of IgE containing cells in the lamina propria of rectal mucosa biopsies. […] As an IgE-mediated immune mechanism was considered to play a role in this type of proctitis, eight of the 12 patients were treated with oral administration of disodium cromoglycate (DSCG). […] We concluded that, in patients with isolated proctitis on clinical and immunopathological criteria, a group can be separated which responds to DSCG, a condition for which we suggest the name 'allergic proctitis’.

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

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

  Eosinophilic gastrointestinal disorders (EGID). Eosinophilia is when your body produces an abnormally high number of white blood cells (eosinophils). White blood cells help your immune system produce an inflammatory response. In eosinophilic gastrointestinal disorders, your immune system sends an abnormally high number of eosinophils to some part of your gastrointestinal tract, causing chronic inflammation there. Researchers think it might be an overreaction to a food allergy. Eosinophilic proctitis mostly affects children under 2. […] Idiopathic proctitis. In a small percentage of people, no direct cause for proctitis can be found. However, these cases often respond to dietary changes. Idiopathic proctitis tends to occur in repeat episodes, almost like a chronic condition. About 10% of cases eventually develop into ulcerative colitis.

• #1

  https://journals.lww.com/ajg/fulltext/2022/10002/s2111_proctitis_in_a_young_male_secondary_to.2111.aspx

  Hydrogen peroxide-induced proctitis can mimic presentation of other conditions such as ulcerative colitis, pseudomembranous colitis, and ischemic colitis. […] Its unclear if anal intercourse after the administration of hydrogen peroxide is linked to pathogenesis of proctitis in this case. Clinical manifestations of hydrogen peroxide-induced proctitis range from self-limited colitis to strictures and perforation, which can lead to other serious complications. The pathogenesis is mainly from corrosive damage, secondary to penetration of the chemical with subsequent formation of oxygen. Most patients recover with conservative therapy. Endoscopic and CT findings of hydrogen peroxide-induced colitis can mimic pseudomembranous colitis, ulcerative colitis, and ischemic colitis, and therefore obtaining detailed, pertinent history is critical to make an accurate diagnosis.

• #1 Radiation Proctitis | IntechOpen

  https://www.intechopen.com/chapters/62503

  Chronic radiation proctitis occurs months to years after treatment with a large majority within 2 years post radiotherapy, and this entity is a troublesome complication in those undergoing pelvic irradiation for any cause. […] The mechanism of anti-inflammatory action of 5-ASA is the inhibition of prostaglandin synthesis. […] Steroids have multiple mechanisms of action that produce anti-inflammatory effects which extend from stabilization of lysosomes in neutrophils to prevent degranulation to upregulation of anti-inflammatory genes via binding to glucocorticoid receptors. […] As oxidative stress is thought to be an important factor in the development of chronic radiation proctitis, antioxidants have been used in an attempt to limit tissue damage. […] HBOT involves patients breathing pure oxygen in a pressurized room or tube. Under these conditions, the lungs can gather more oxygen than at normal air pressure. Higher oxygenated blood may inhibit bacterial growth and stimulate the release of growth factors and stem cells; thus, it affects and promotes wound healing.

• #1 Efficacy and Mechanism of Action of Ginsenoside Rg3 on Radiation Proctitis in Rats | Opast Publishing Group

  https://www.opastpublishers.com/peer-review/efficacy-and-mechanism-of-action-of-ginsenoside-rg3-on-radiation-proctitis-in-rats-7852.html

  Radiation proctitis (RP) refers to rectal injury caused by radiation treatment of pelvic and retroperitoneal malignancies, which has a major impact on the treatment prognosis and quality of life of patients with cancer. […] Here, we validated its efficacy and elucidated its mechanism of action. […] GRg3 significantly improved the general condition and histopathological damage in rats with RP. Moreover, GRg3 decreased the levels of factors that promote inflammation (TNF-) and increased the levels of factors that reduce inflammation (IL-4 and IL-10). GRg3 markedly reduced the activation of NF-B and caspase-8 signaling pathways. […] Thus, GRg3 may reduce the inflammatory response by blocking the NF-B signaling pathway and improving the balance of inflammation-related factors. GRg3 may also inhibit intestinal cell apoptosis by suppressing the TNF-/caspase-8 signaling cascade, thereby reducing radiological rectal injury. Our results verify that GRg3 is a promising therapeutic agent for RP treatment and shed light on its mechanism.

• #1

  https://www.scielo.br/j/acb/a/sMzryBM4qc758dkynbXKwJM/?lang=en

  Changrui enema is an effective treatment with fewer side effects for ARP. The mechanism of Changrui enema may be related to the inhibition of inflammation-induced angiogenesis. Changrui enema inhibits IL-1 and NF-B expression as well as VEGF expression. […] The study firstly found that Changrui enema alleviated ARP mice. […] Nuclear factor-kappa B (NF-B) is a heterodimeric transcription factor that plays a key role in inflammatory. NF-B promotes the transcription of IL-1. NF-B and IL-1 may amplify inflammation in the early stage of radiation proctitis. […] Our study also found that the high expression of NF-B was accompanied by increased VEGF in rectal tissue of ARP mice. Dexamethasone combined with gentamicin inhibited the expression of VEGF by down-regulating NF-B in rectal tissue of ARP mice. […] We proposed that inflammation-induced angiogenesis played a key role in ARP. […] Our findings suggest that Changrui may inhibit AQP1 expression by down-regulating p-ERK1/2, and improves AQP3 expression by up-regulating p-JNK.

• #1 Radiation-Induced Proctitis in Rat and Role of Nitric Oxide

  https://www.e-roj.org/journal/view.php?number=551

  Proctitis is one of acute complications encountered when radiotherapy was applied to the pelvis. […] This study was aimed to establish the optimal radiation dose for radiation-induced proctitis in rat and to find a relationship between radiation proctitis and NO production. […] A single fraction of 17.5 Gy irradiation to the rat rectum considered to be an optimal dose for radiation induced proctitis model. These results indicated that an excess production of NO contributes to pathogenesis of radiation-induced proctitis in part but was not the direct cause of rectal damage.

• #1 Actinic Proctitis and Scientific Evidence of its Treatment with Hyperbaric Oxygen Therapy – Dr. Rolando Loría

  https://drrolandoloria.com/actinic-proctitis-and-scientific-evidence-of-its-treatment-with-hyperbaric-oxygen-therapy/

  Actinic proctitis is an inflammation of the rectum caused by radiation therapy, commonly given to treat cancers in the pelvic region, such as cancer of the prostate, rectum, cervix, and bladder. […] HBOT increases the partial pressure of oxygen in damaged tissues, which improves cellular oxygenation and promotes tissue repair. […] HBOT modulates the inflammatory response, reducing chronic inflammation and edema. […] The therapy promotes cell proliferation, collagen synthesis and epithelial regeneration, accelerating the healing of damaged tissues. […] A randomized controlled study conducted by Clarke et al. (2008) demonstrated that patients with actinic proctitis treated with HBOT showed a significant improvement in clinical symptoms, such as rectal pain and bleeding, compared to the control group that received conventional treatment.

• #1

  https://journals.lww.com/cancerjournal/fulltext/2023/19030/argon_plasma_coagulation_therapy_in_hemorrhagic.31.aspx

  Radiation causes both apoptosis and cell death secondary to damage to DNA, proteins, and lipids and usually affects rapidly proliferating cells such as those found in cancer and other normal cells. […] The pathological process is different from the acute phase and involves the decrease in blood supply to the rectal wall leading to full-thickness ischemia and fibrotic changes. […] Oxidative stress is thought to be a major mechanism in the development of chronic radiation proctitis. […] The management of chronic proctitis can be divided into noninvasive treatments (anti-inflammatory agents, sucralfate, short-chain fatty acids, hyperbaric oxygen, and antioxidants) and invasive treatments (ablation and surgery). […] APC uses high-frequency energy (monopolar diathermy) transmitted to the tissue through an ionized gas in a noncontact fashion. […] Its ability to control bleeding throughout the gastrointestinal tract has been demonstrated, and it has advantage of very limited tissue penetration, making it ideal for treatment of superficial bleeding.

• #1 Chronic haemorrhagic radiation proctitis: A review

  https://www.wjgnet.com/1948-9366/full/v8/i7/483.htm

  Formalin scleroses and seals fragile neovasculature in tissues damaged due to radiation and prevents further bleeding. […] The technique and the concentration of formalin used in these studies also differ. […] Four percent formalin should be the first line treatment for patients with CHRP. […] Formalin and argon plasma coagulation (APC) are equally effective, but formalin is better for severe disease. […] Refractory patients, not responding to formalin or APC, need to be referred for hyperbaric oxygen therapy or surgery. […] Radio-frequency ablation is a promising modality that needs to be studied further in randomized trials.

• #1 Cellceutix begins Phase II trial of Brilacidin to treat ulcerative proctitis – Clinical Trials Arena

  https://www.clinicaltrialsarena.com/news/newscellceutix-begins-phase-ii-trial-brilacidin-treat-ulcerative-proctitis-4926105/

  Brilacidin is a new class of antibiotics called defensin-mimetics that replicate the bodys innate host-defence response. […] The Proof of Concept trial is designed to evaluate the ability of Brilacidin to cure ulcerative proctitis. […] Ulcerative proctitis is a mucosal inflammatory disease characterised by rectum inflammation, redness, and ulcerations of the lining of the rectum. […] Brilacidin, with its anti-inflammatory properties, terminates bacteria in a quick and efficient way, penetrating bacterial cell wall membranes. […] Its defence mechanism weakens the resistance of the bacteria. […] Brilacidin also functions as an immunomodulatory capacity, reducing inflammation and promoting healing.

• #1 Management of radiation-induced proctitis using submucosal endoscopic injections of autologous adipose-derived stromal vascular fraction: a case report | Stem Cell Research & Therapy | Full Text

  https://stemcellres.biomedcentral.com/articles/10.1186/s13287-024-04017-3

  Standard approaches to the treatment of chronic post-radiation proctitis are associated with a high risk of complications and a high percentage of unsatisfactory results due to the reduced regenerative potential of irradiated tissues. […] The techniques of regenerative surgery appear thus most preferable due to their direct effect on the pathogenetic mechanisms of post-radiation pathological changes. […] The deficit of the tissues regenerative potential after radiation therapy prioritizes the search for any approaches to the stimulation of regeneration in the radiation-affected rectum. […] MSC launch immune modulation, neovascularization and are characterized by pronounced antifibrotic properties. […] The safety and efficiency of allogeneic MSC and their derivates in the therapy of post-radiation proctitis in humans is still to be studied.

• #1 Management of radiation-induced proctitis using submucosal endoscopic injections of autologous adipose-derived stromal vascular fraction: a case report | Stem Cell Research & Therapy | Full Text

  https://stemcellres.biomedcentral.com/articles/10.1186/s13287-024-04017-3

  The experience of Russian coloproctologists has demonstrated that adipose-derived autologous SVF is safe and efficient in the treatment of post-radiation lesions, including proctitis and rectovaginal fistulae. […] The oncological safety of autologous adipose-derived bioproducts has been proven by a number of studies and should not be a limiting factor for the technique implementation. […] Thus, the treatment of this patient prior to the SVF administration may be considered a rescue experiment, in which no active component was applied.

• #1 Chronic radiation proctitis refractory to steroid enema was successfully treated by metformin and sodium butyrate: a case report | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-024-04551-x

  Radiation proctitis (RP) is a significant complication of pelvic radiation. Effective treatments for chronic RP are currently lacking. […] The pathogenesis of chronic RP primarily involves vascular ectasia. […] From a pathological perspective, chronic RP is characterized by radiation-induced vascular abnormalities intertwined with inflammation, termed radiation-associated vascular ectasia. […] The M-B synergism may contribute to restoring epithelial homeostasis and normalizing vascular ectasia in chronic RP. […] One hypothesis suggests that M-B combination might directly enhance M2 macrophage polarization, while another suggests it may indirectly prevent M2 macrophage senescence. […] However, the precise mechanism by which M-B prevents M2 macrophage senescence requires further investigation.

• #1 Ulcerative colitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/ulcerative-colitis?lang=us

  Environmental and genetic factors are thought to play a role in the pathogenesis, although the condition remains idiopathic. […] Unlike Crohn disease which is characteristically a transmural disease, ulcerative colitis is usually limited to the mucosa and submucosa.

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

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

  Under normal circumstances, proctitis isnt life-threatening and responds well to treatment. But it could lead to more serious complications if it: Is severe. Lasts a long time. Goes untreated. Doesnt respond to treatment. […] Complications from prolonged inflammation can include: Excessive bleeding, leading to anemia. Fistulas (tunnels through your rectum wall). Stricture or stenosis (scarring of the tissues, causing your rectum to narrow). […] 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 Health Library

  https://www.limamemorial.org/health-library/Complementary%20and%20Alternative%20Medicine/33/000134

  In more severe cases of proctitis from radiation therapy, ablation therapy may be used to destroy bleeding tissue. […] Complications can range from ulcers and boils to severe bleeding. Proctitis related to ulcerative colitis may spread to more areas of the colon and other parts of the digestive tract.

• #1 Ulcerative Colitis vs Proctitis: What’s the Difference?

  https://www.verywellhealth.com/ulcerative-proctitis-vs-colitis-5204479

  Ulcerative proctitis may be triggered by various factors, but no single cause has been identified. Family history and an overactive immune system may contribute to its development. […] The exact cause of ulcerative colitis is poorly understood. […] Both conditions are autoimmune diseases. They occur when the immune system mistakenly attacks the lining of the rectum and/or colon. […] Research shows people with UP who have one or more symptom flares in the first year following diagnosis are most likely to develop UC over time. […] Ulcerative proctitis does not increase the risk of colon cancer.

• #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.

• #2 Proctitis | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/116488/all/Proctitis?q=Inflammatory+bowel+disease

  Acute or chronic inflammation of the rectal mucosa […] Chronic radiation proctitis secondary to ischemic and fibrotic changes […] DP: Proximal fecal diversion causes increased nitrate-reducing bacteria and decreased obligate anaerobes resulting in short-chain fatty acids (SCFAs) deficiency […] Rectal intercourse in women or MSM can result in proctocolitis […] In genetically predisposed individuals with dysregulated immune responses, GI infections may increase the risk of UP […] Radiation injury occurs with doses 8 Gy or higher, causing damage to intestinal cell DNA with helical breaks, inability to replicate and undergo normal cellular repair.

• #2 Health Library

  https://www.limamemorial.org/health-library/Complementary%20and%20Alternative%20Medicine/33/000134

  In more severe cases of proctitis from radiation therapy, ablation therapy may be used to destroy bleeding tissue. […] Complications can range from ulcers and boils to severe bleeding. Proctitis related to ulcerative colitis may spread to more areas of the colon and other parts of the digestive tract.

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

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

  Proctitis is inflammation inside your rectum, which is the lower end of your large intestine just before your anus. Procto means rectum, and itis means inflammation. Your rectum can become inflamed if bacteria or chemicals irritate the inner lining, or if its affected by inflammatory bowel disease. It can cause uncomfortable symptoms, such as pain, rectal bleeding and poop changes. […] Proctitis has several possible causes, some more common than others. […] Inflammatory bowel disease (IBD). Crohns disease and ulcerative colitis cause chronic inflammation in different parts of your bowels. Up to 30% of people affected by one of these diseases experience inflammation primarily in their rectum. This is the most common cause of proctitis overall. […] Radiation therapy for cancer can cause radiation mucositis anywhere in your gastrointestinal tract. That means that the mucous lining inside your GI (gastrointestinal) tract becomes inflamed. Radiation enteritis and radiation colitis are common when you have targeted radiation to your upper or lower abdomen. You can get radiation proctitis if you have targeted radiation to your pelvic area.

• #2 Ulcerative Colitis vs Proctitis: What’s the Difference?

  https://www.verywellhealth.com/ulcerative-proctitis-vs-colitis-5204479

  Ulcerative proctitis may be triggered by various factors, but no single cause has been identified. Family history and an overactive immune system may contribute to its development. […] The exact cause of ulcerative colitis is poorly understood. […] Both conditions are autoimmune diseases. They occur when the immune system mistakenly attacks the lining of the rectum and/or colon. […] Research shows people with UP who have one or more symptom flares in the first year following diagnosis are most likely to develop UC over time. […] Ulcerative proctitis does not increase the risk of colon cancer.

• #2 Proctitis and Anusitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27770

  Proctitis and anusitis may happen secondary to ulcerative colitis (UC), Chronic Radiation Proctitis, Proctopathy (CRP), or Diversion Proctitis (DP). […] In genetically predisposed individuals with dysregulated immune responses, GI infections may increase the risk of ulcerative proctitis (UP). Appendectomy and smoking appeared to act as protective factors from UP. CRP occurs secondary to ischemic and fibrotic changes. In the case of DP, proximal fecal diversion causes increased nitrate-reducing bacteria and decreased obligate anaerobes resulting in short-chain fatty acids deficiency. Rectal intercourse in women or MSM can result in proctocolitis. Radiation injury occurs with doses 8 Gy or higher causing damage to intestinal cell DNA with helical breaks and inability to replicate and undergo normal cellular repair.

• #2 Efficacy and Mechanism of Action of Ginsenoside Rg3 on Radiation Proctitis in Rats | Opast Publishing Group

  https://www.opastpublishers.com/peer-review/efficacy-and-mechanism-of-action-of-ginsenoside-rg3-on-radiation-proctitis-in-rats-7852.html

  Radiation proctitis (RP) refers to rectal injury caused by radiation treatment of pelvic and retroperitoneal malignancies, which has a major impact on the treatment prognosis and quality of life of patients with cancer. […] Here, we validated its efficacy and elucidated its mechanism of action. […] GRg3 significantly improved the general condition and histopathological damage in rats with RP. Moreover, GRg3 decreased the levels of factors that promote inflammation (TNF-) and increased the levels of factors that reduce inflammation (IL-4 and IL-10). GRg3 markedly reduced the activation of NF-B and caspase-8 signaling pathways. […] Thus, GRg3 may reduce the inflammatory response by blocking the NF-B signaling pathway and improving the balance of inflammation-related factors. GRg3 may also inhibit intestinal cell apoptosis by suppressing the TNF-/caspase-8 signaling cascade, thereby reducing radiological rectal injury. Our results verify that GRg3 is a promising therapeutic agent for RP treatment and shed light on its mechanism.

• #2 KoreaMed Synapse

  https://synapse.koreamed.org/articles/1516078407

  The pathogenesis of RP is complex and yet to be fully understood. To better comprehend the pathogenic process, it is divided into two sections. […] It is essential to first understand the mechanism by which ionizing radiation causes damage to tissues at the cellular level. The damage to tissues secondary to RT is widespread; however, in essence, both direct and indirect mechanisms of tissue damage via radiation target cellular deoxyribonucleic acid (DNA), thereby inhibiting transcription and preventing cellular replication. […] The mucosa of the GI tract is highly proliferative. As per the literature, enterocytes have the highest turnover rate of any fixed cell in the body. Hence, the rapidly dividing mucosal stem cells present within the crypts of Lieberkhn are highly susceptible to radiation injury. Initiation of RP occurs via radiation-induced damage to the mucosa, followed by late indolent connective tissue growth and remodeling, and subsequently tissue response to the ongoing ischemia. […] Additionally, radiation can directly damage the vascular and endothelial cells leading to full-thickness bowel ischemia; hence, it plays a major role in the pathogenesis of RP.

• #2 Radiation Proctitis and Management Strategies

  https://www.e-ce.org/journal/view.php?number=7593

  An acute inflammatory response may be generated after exposure to the bacteria, often involving T-lymphocytes, macrophages, and neutrophils. […] On gross visualization, early radiation injury will show edema, mucosal hyperemia, and ulceration of the tissue. […] Histological changes of early radiation damage may be seen within a few hours of RT, followed by infiltration of leukocytes and crypt abscess formation in 24 weeks. […] Subsequently, progressive occlusive vasculitis with foam cell invasion of the intima and hyaline thickening of the media of arterioles may be seen, which contributes to obliterative endarteritis, leading to full-thickness ischemia of the bowel wall. […] After cessation of RT, the acute inflammatory process subsides, and intestinal crypt cells start to regenerate.

• #2 Radiation Proctitis and Management Strategies

  https://www.e-ce.org/journal/view.php?number=7593

  However, in some patients, for reasons unknown, the inflammatory process may exaggerate, leading to ulceration of the mucosa followed by fibrosis and the development of chronic inflammatory changes. […] Additionally, radiation can directly damage the vascular and endothelial cells leading to full-thickness bowel ischemia; hence, it plays a major role in the pathogenesis of RP.

• #2 Radiation proctitis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Radiation_proctitis_pathophysiology

  Secondary to significant production of enzymes and reactive oxygen metabolites by these inflammatory cells, further degradation of the extracellular matrix and injury to mucosal and submucosal tissue ensures, causing further damage to the bowel wall. […] However, progressive exposure causes ulceration followed by progressive fibrosis and the development of chronic inflammatory changes associated with chronic symptoms. […] Endothelial damage causes arterial sclerosis with obliterative endarteritis of small vessels, leading to chronic ischemia and associated fibrosis. […] These changes can lead to ulcers, bleeding, stenosis, strictures, fistulas, and bleeding.

• #2 Complementary and Alternative Medicine – Proctitis

  https://broadlawns.adam.com/content.aspx?productid=107&pid=33&gid=000134

  Proctitis is an inflammation of the lining of the rectum, the end of the large intestine where stool passes through. […] A number of conditions can cause proctitis. Sexually transmitted diseases (STDs) are the most common: […] Proctitis caused by IBD. Your doctor will work to reduce the inflammation caused by your IBD. […] Complications can range from ulcers and boils to severe bleeding. Proctitis related to ulcerative colitis may spread to more areas of the colon and other parts of the digestive tract.

• #3 Proctitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/proctitis?lang=us

  Proctitis refers to acute or chronic inflammation of the lining of the rectum (rectal mucosa). […] Proctitis may result from a number of pathologies: infection – infective proctitis, ischemia – ischemic proctitis, radiation – radiation proctitis, fecal impaction – stercoral proctitis.

• #3 Proctitis | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/116488/all/Proctitis?q=Abscess+Anorectal

  Acute or chronic inflammation of the rectal mucosa […] Chronic radiation proctitis secondary to ischemic and fibrotic changes […] DP: Proximal fecal diversion causes increased nitrate-reducing bacteria and decreased obligate anaerobes resulting in short-chain fatty acids (SCFAs) deficiency […] Rectal intercourse in women or MSM can result in proctocolitis […] In genetically predisposed individuals with dysregulated immune responses, GI infections may increase the risk of UP.

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