eMedicine Specialties > Emergency Medicine > Gastrointestinal

Proctitis: Follow-up

Author: Lisandro Irizarry, MD, MPH, FAAEM, Chair, Department of Emergency Medicine, Brooklyn Hospital Center; Assistant Professor, Department of Emergency Medicine, Weill Cornell School of Medicine
Coauthor(s): Ibis Yarde, MD, Staff Physician, Department of Emergency Medicine, Brooklyn Hospital Center
Contributor Information and Disclosures

Updated: Apr 27, 2009

Follow-up

Further Outpatient Care

  • Discharge if no life-threatening condition exists and the patient is able to comply with the therapeutic regimen.
  • Discharge should include follow-up with a colorectal surgeon or gastroenterologist who will monitor the patient's progress clinically and endoscopically, in addition to following results of cultures, labs, and biopsies.

Inpatient & Outpatient Medications

  • Maintenance medical therapy is not used routinely in idiopathic proctitis unless the patient’s condition is slow to respond, difficult to control, or has frequent flare-ups.
  • In radiation proctitis, no evidence indicates that corticosteroids, and/or the various aminosalicylic acid derivations given as an enema or orally, are beneficial in preventing the progression of the disease.

Complications

  • Chronic ulcerative colitis
  • Fistula formation
  • Abscess
  • Treatment failure
  • Perforation

Prognosis

  • Failure rates as high as 35% have been reported following treatment of rectal gonorrhea; symptoms frequently recur.
  • Most surgeons favor a diverting colostomy for medically intractable proctitis.

Patient Education

 


More on Proctitis

Overview: Proctitis
Differential Diagnoses & Workup: Proctitis
Treatment & Medication: Proctitis
Follow-up: Proctitis
References
Further Reading
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References

  1. Babb RR. Radiation proctitis: a review. Am J Gastroenterol. Jul 1996;91(7):1309-11. [Medline].

  2. Bassford T. Treatment of common anorectal disorders. Am Fam Physician. Apr 1992;45(4):1787-94. [Medline].

  3. Bitton A. Medical Management of Ulcerative Proctitis, Proctosigmoiditis, and left-sided colitis. Semin Gastrointest Dis. 2001;12(4):263-274. [Medline].

  4. Denton AS, Andreyev HJ, Forbes A, Maher EJ. Systematic review for non-surgical interventions for the management of late radiation proctitis. Br J Cancer. Jul 15 2002;87(2):134-43. [Medline].

  5. Rafal RB, Nichols JN, Cennerazzo WJ, et al. MRI for evaluation of perianal inflammation. Abdom Imaging. May-Jun 1995;20(3):248-52. [Medline].

  6. Regueiro MD. Diagnosis and treatment of ulcerative proctitis. J Clin Gastroenterol. Oct 2004;38(9):733-40. [Medline].

  7. Spencer CM, McTavish D. Budesonide. A review of its pharmacological properties and therapeutic efficacy in inflammatory bowel disease. Drugs. Nov 1995;50(5):854-72. [Medline].

  8. MacDermott RP. Management of ulcerative proctitis, proctosigmoiditis and left sided colitis. Available at www.uptodate.com. Accessed March 31, 2009.

  9. Nostrant TT. Diagnosis and treatment of chronic radiation proctitis. Up to Date. Available at www.uptodate.com. Accessed March 31, 2009.

  10. Kornbluth A, Sachar DB. Ulcerative colitis practice guidelines in adults (update): American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol. Jul 2004;99(7):1371-85. [Medline].

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Further Reading

Clinical guidelines

Proctitis, proctocolitis, and enteritis. Sexually transmitted diseases treatment guidelines 2006. Centers for Disease Control and Prevention, Workowski KA, Berman SM. Proctitis, proctocolitis, and enteritis. Sexually transmitted diseases treatment guidelines 2006. MMWR Morb Mortal Wkly Rep 2006 Aug 4;55(RR-11):78.

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Keywords

inflammation of the rectum, rectal mucosa, proctosigmoiditis, rectal tissue ischemia, rectal pain, rectal bleeding, proctitis, mucosal cell loss, acute inflammation of the lamina propria, eosinophilic crypt abscess, endothelial edema of the arterioles, mucosal friability, ulcers, strictures, fistula formation, colitis, Crohn disease, Crohn's disease, ulcerative colitis

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Contributor Information and Disclosures

Author

Lisandro Irizarry, MD, MPH, FAAEM, Chair, Department of Emergency Medicine, Brooklyn Hospital Center; Assistant Professor, Department of Emergency Medicine, Weill Cornell School of Medicine
Lisandro Irizarry, MD, MPH, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Ibis Yarde, MD, Staff Physician, Department of Emergency Medicine, Brooklyn Hospital Center
Disclosure: Nothing to disclose.

Medical Editor

Michael S Beeson, MD, MBA, FACEP, Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine; Program Director, Emergency Medicine Residency, Summa Health System
Michael S Beeson, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Eugene Hardin, MD, FAAEM, FACEP, Former Chair and Associate Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine, Martin Luther King Jr/Drew Medical Center
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH, Professor and Chair, Department of Emergency Medicine, University of Virginia Health System
Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
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