From the Guidelines
Proctitis treatment involves addressing the underlying cause and managing symptoms, with mesalamine suppositories (1g daily) being the preferred initial treatment for mild or moderately active proctitis, as recommended by the European Crohn’s and Colitis Organisation (ECCO) 1.
Treatment Options
- For infectious proctitis, antibiotics are the primary treatment, with specific antibiotics depending on the cause, such as ceftriaxone for gonorrhea or doxycycline for chlamydia.
- Inflammatory proctitis from conditions like ulcerative proctitis typically requires anti-inflammatory medications, with mesalamine suppositories being more effective than topical steroids 1.
- Radiation proctitis can be treated with sucralfate enemas to help heal the mucosa.
Symptomatic Relief
- Sitz baths, increased fiber intake, and over-the-counter pain relievers can provide symptomatic relief for all types of proctitis.
- Severe cases may require oral corticosteroids like prednisone 40mg daily with a gradual taper.
Importance of Correct Diagnosis
- Treatment effectiveness depends on correctly identifying the cause of proctitis, as different etiologies require specific approaches.
- Most cases resolve with appropriate treatment, though chronic inflammatory conditions may require maintenance therapy.
Additional Considerations
- The AGA recommends using mesalamine suppositories in patients with mild-moderate ulcerative proctitis who opt for rectal therapy, with a pooled analysis of 4 RCTs showing that mesalamine suppositories are more effective than placebo in inducing remission 1.
- The British Society of Gastroenterology consensus guidelines also recommend topical mesalamine as the first-line therapy for proctitis, with steroid suppositories being effective but not as effective as 5-ASA 1.
From the FDA Drug Label
The mechanism of action of mesalamine is not fully understood, but it appears to have a topical anti-inflammatory effect on the colonic epithelial cells Mucosal production of arachidonic acid metabolites, both through the cyclooxygenase and lipoxygenase pathways, is increased in patients with ulcerative colitis, and it is possible that mesalamine diminishes inflammation by blocking cyclooxygenase and inhibiting prostaglandin production in the colon.
The treatment options for proctitis (inflammation of the rectum) may include mesalamine, which has a topical anti-inflammatory effect on the colonic epithelial cells.
- Mesalamine is an aminosalicylate with anti-inflammatory properties.
- It may help reduce inflammation in the rectum by inhibiting prostaglandin production. 2
From the Research
Treatment Options for Proctitis
The treatment options for proctitis, an inflammation of the rectum, vary depending on the underlying cause.
- For infectious proctitis, treatment may involve antibiotics or antiviral medications, as seen in cases caused by pathogens such as Neysseria gonorrhoeae, Chlamydia trachomatis, Herpes Simplex virus, and Treponema pallidum 3.
- In the case of ulcerative proctitis, a subcategory of ulcerative colitis, treatment options include:
- Topical aminosalicylates, which are effective first-line agents and can induce and maintain remission more effectively than oral counterparts or topical steroids 4, 5, 6.
- Oral aminosalicylates, which have been the mainstay of acute and maintenance therapy, but are less effective than topical treatments 4.
- Systemic corticosteroids, antibiotics, immunomodulators, or surgery, which may be required in rare cases where ulcerative proctitis is refractory to topical therapy 4, 5.
- Mesalazine suppository is considered a first-line therapy for patients with ulcerative proctitis due to its high effectiveness and safety, and is more effective than dose intensification of oral mesalazine for relapsed patients 6.
- For proctitis caused by other factors, such as radiation or ischemia, treatment may involve addressing the underlying cause and managing symptoms 3.
- A comprehensive history, clinical evaluation, and rectal nucleic amplification STI testing may be useful in identifying the cause of proctitis and targeting treatment 7.