From the Guidelines
Treatment for proctitis should prioritize mesalamine suppositories (1g daily) as the first-line therapy to induce symptomatic remission, as recommended by the AGA clinical practice guidelines 1. For inflammatory bowel disease-related proctitis, mesalamine suppositories or enemas are effective treatments, often combined with oral mesalamine (2-4g daily) 1. Key points to consider in the treatment of proctitis include:
- The use of rectal mesalamine, such as suppositories or enemas, is preferred for proctitis due to its targeted delivery and effectiveness 1.
- Oral mesalamine can be used in combination with rectal therapy for more extensive disease or for patients who prefer oral medication, but it is not the first choice for proctitis 1.
- Corticosteroid suppositories or enemas may be added for more severe cases or for patients who do not respond to mesalamine therapy 1.
- Supportive care, including sitz baths, increased fluid intake, and dietary modifications, is important for managing symptoms and reducing irritation.
- Pain management with acetaminophen or prescription pain relievers may be necessary for some patients.
- Treatment duration and approach may vary depending on the underlying cause of proctitis, with infectious causes typically requiring shorter treatment courses and chronic conditions requiring ongoing management 1. Given the evidence, mesalamine suppositories (1g daily) are the recommended first-line treatment for proctitis, with adjustments made based on patient response, disease severity, and specific circumstances 1.
From the Research
Treatment for Proctitis
The treatment for proctitis depends on the underlying cause of the condition.
- For infectious proctitis, treatment is based on antibiotics or antivirals, which may be empirically initiated 2.
- In cases of chlamydial proctitis, doxycycline has been shown to be effective in resolving symptoms 3.
- For ulcerative proctitis, topical aminosalicylates are effective first-line agents, while oral aminosalicylates, topical steroids, systemic corticosteroids, antibiotics, immunomodulators, or surgery may be required in refractory cases 4.
- The 2021 European Guideline on the management of proctitis, proctocolitis and enteritis caused by sexually transmissible pathogens provides guidance on the diagnosis and management of patients with gastrointestinal symptoms and a suspected sexually transmitted cause 5.
Considerations for Treatment
When treating proctitis, it is essential to consider the following:
- Obtaining a detailed sexual history to identify potential risk factors for sexually transmitted infections (STIs) 3, 2, 5.
- Performing a comprehensive history, clinical evaluation, including anoscopy, and rectal nucleic amplification STI testing to identify the cause of proctitis and target treatment 6.
- Testing for co-infections, such as HIV, and treating sexual partners accordingly 3, 2, 5.
- Considering the potential for evolving data to support a role for Mycoplasma genitalium in proctitis 6.