Ulcerative proctitis: an update on the pharmacotherapy and management.
BACKGROUND
Ulcerative colitis (UC) presents as proctitis in approximately a quarter of the patients. It may progress into left-sided or extensive colitis in up to 50% of cases upon long-term follow-up.


METHODS
Currently available data on ulcerative proctitis are summarized and critically reviewed. Extensive literature search (MEDLINE) was performed to identify relevant articles up to March 2014.


CONCLUSIONS
The short-term goal of the treatment in UC is to induce remission, whereas long-term goals are to maintain remission and prevent disease progression. Topically administered 5-aminosalicylates (5-ASA) and corticosteroids are effective in the treatment of proctitis, although they seem to be underused in everyday practice. Locally administered 5-ASA preparations are more effective than oral compounds. The combination of topical and oral 5-ASA and steroids should be considered for escalation of treatment. Refractory patients should be re-evaluated to exclude for compliance failures, infections or proximal disease extent. True refractory or steroid-dependent patients may require immunomodulators or biological therapy. Alternative medicine can be used complementarily, while experimental approaches are reserved for patients failing conventional medication. Proctocolectomy may be the last resort of treatment. Upon long-term, 5-ASA maintenance treatment is indicated in all UC cases to prevent relapse and disease progression.
Semmelweis University, 1st Department of Medicine , Korányi Sándor utca 2a, H1083 Budapest , Hungary +36 20 9117727 ; +36 1 3130250 ; lakatos.peter_laszlo@med.semmelweis-univ.hu.
Krisztina B
KB
Gecse
Peter L
PL
Lakatos
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D019468:Disease Management; D006801:Humans; D019804:Mesalamine / Q000008:administration & dosage; D011239:Prednisolone / Q000008:administration & dosage; D011349:Proctitis / Q000188:drug therapy*; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D019804:Mesalamine; D011239:Prednisolone
5-aminosalicylates; azathioprine; infliximab; steroids; therapy; ulcerative colitis; ulcerative proctitis