From the Guidelines
Treatment for proctitis should start with topical mesalamine suppositories (1g daily) as the first-line therapy to induce symptomatic remission, as recommended by the AGA and ECCO guidelines 1. The choice of treatment for proctitis depends on the underlying cause, with different approaches for infectious, inflammatory bowel disease-related, and radiation-induced proctitis. For inflammatory bowel disease-related proctitis, topical mesalamine is the preferred initial treatment due to its superiority over topical corticosteroids in inducing remission 1. Key points to consider in the management of proctitis include:
- Topical mesalamine suppositories are more effective than topical corticosteroids for inducing remission in proctitis 1.
- The use of rectal corticosteroids may be considered for patients who do not respond to or cannot tolerate mesalamine suppositories 1.
- Oral 5-ASA preparations may be used in combination with topical therapy for more extensive disease or for patients who do not respond to topical therapy alone 1.
- Supportive care, including pain management, increased fluid intake, and a low-residue diet, is important for all types of proctitis 1.
- Severe cases unresponsive to medical therapy may require surgical intervention, including temporary diversion or, rarely, proctectomy 1. Given the potential for complications and the importance of prompt treatment, it is crucial to initiate therapy as soon as possible after diagnosis. The AGA and ECCO guidelines provide a framework for the management of proctitis, emphasizing the use of topical mesalamine as the first-line treatment and the consideration of other therapies, such as rectal corticosteroids and oral 5-ASA preparations, for patients who do not respond to initial therapy 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE ROWASA is indicated for the treatment of active mild to moderate distal ulcerative colitis, proctosigmoiditis or proctitis in adults.
The treatment option for proctitis is mesalamine (PR), specifically ROWASA Rectal Suspension Enema, as indicated in the drug label 2.
- Key points:
- Mesalamine is used to treat active mild to moderate distal ulcerative colitis, proctosigmoiditis, or proctitis in adults.
- ROWASA Rectal Suspension Enema has been shown to reduce the overall disease activity index (DAI) and individual components in patients with active distal ulcerative colitis, proctosigmoiditis, or proctitis 2, 2.
From the Research
Treatment Options for Proctitis
The treatment options for proctitis depend on the underlying cause of the condition.
- For ulcerative proctitis, topical aminosalicylates are effective first-line agents, acting more effectively and rapidly to induce and maintain remission compared to oral counterparts or topical steroids 3.
- In cases where ulcerative proctitis is refractory to topical therapy, systemic corticosteroids, antibiotics, immunomodulators, or surgery may be required 3.
- For proctitis associated with sexually transmitted infections (STIs), such as gonorrhea, chlamydia, and syphilis, treatment should be targeted at the underlying cause 4.
- Empirical therapy with antibiotics, such as doxycycline, may be effective in managing acute proctitis in certain patient populations, such as homosexual men 5.
- Mesalazine suppository is considered a first-line therapy for patients with ulcerative proctitis due to its high effectiveness and safety 6.
- For herpes simplex virus proctitis, oral acyclovir has been shown to be effective in reducing the duration of rectal lesions and viral excretion 7.
Considerations for Treatment
- A comprehensive history, clinical evaluation, and rectal nucleic amplification STI testing may be useful in identifying the cause of proctitis and targeting treatment 4.
- Differential diagnosis from other chronic proctitis is important and should be performed based on clinical history and endoscopical and histological features 6.
- Adherence to rectal mesalazine therapy is crucial for achieving remission in patients with ulcerative proctitis 6.