Proctitis in Emergency Medicine Follow-up

  • Author: Lisandro Irizarry, MD, MPH, FAAEM; Chief Editor: Robert E O'Connor, MD, MPH   more...
 
Updated: Jun 2, 2010
 

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.
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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, there is no evidence that indicates that corticosteroids and/or various aminosalicylic acid derivations given as an enema or orally are beneficial in preventing the progression of the disease.
  • In hemorrhagic proctitis, formaldehyde is effective in controlling bleeding with no serious complication, but further studies are needed.[4]
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Complications

Complications of proctitis may include the following:

  • Chronic ulcerative colitis
  • Fistula formation
  • Abscess
  • Treatment failure
  • Perforation
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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.
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Patient Education

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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.

Specialty Editor Board

Michael S Beeson, MD, MBA, FACEP  Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine and Pharmacy; Attending Faculty, Akron General Medical Center

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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.

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.

References
  1. Nostrant TT. Diagnosis and treatment of chronic radiation proctitis. October 7, 2009. Accessed. March 14, 2010. UpToDate [online].

  2. Hille A, Schmidt-Giese E, Hermann RM, Herrmann MK, Rave-Frank M, Schirmer M, et al. A prospective study of faecal calprotectin and lactoferrin in the monitoring of acute radiation proctitis in prostate cancer treatment. Scand J Gastroenterol. Jan 2008;43(1):52-8. [Medline].

  3. Karamanolis G, Triantafyllou K, Tsiamoulos Z, Polymeros D, Kalli T, Misailidis N, et al. Argon plasma coagulation has a long-lasting therapeutic effect in patients with chronic radiation proctitis. Endoscopy. Jun 2009;41(6):529-31. [Medline].

  4. Haas EM, Bailey HR, Farragher I. Application of 10 percent formalin for the treatment of radiation-induced hemorrhagic proctitis. Dis Colon Rectum. Feb 2007;50(2):213-7. [Medline].

  5. de Parades V, Etienney I, Bauer P, Bourguignon J, Meary N, Mory B, et al. Formalin application in the treatment of chronic radiation-induced hemorrhagic proctitis--an effective but not risk-free procedure: a prospective study of 33 patients. Dis Colon Rectum. Aug 2005;48(8):1535-41. [Medline].

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

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

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

  9. 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].

  10. [Guideline] 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].

  11. Liauw SL, Sylvester JE, Morris CG, Blasko JC, Grimm PD. Second malignancies after prostate brachytherapy: incidence of bladder and colorectal cancers in patients with 15 years of potential follow-up. Int J Radiat Oncol Biol Phys. Nov 1 2006;66(3):669-73. [Medline].

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

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

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

  15. 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].

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