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Thursday, 5 December 2013

Proctitis – Diseases associated with Proctitis

Proctitis is defined as a condition of inflammation of the anus and the lining of the rectum (i.e., the distal 10–12 cm) of that can lead to bowl discomfort, bleeding, a discharge of mucus or pus, etc.
B. Diseases associated with Proctitis
1. Inflammatory bowel diseases (IBD) and sexual transmitted infections
Proctitis is a common problem and is most frequently associated with inflammatory bowel diseases (IBD). However, in the last ten years the incidence of infectious proctitis appears to be rising, especially in men who have sex with men. This may be due to the rise of people participating in receptive anal sex as well as the increase in sexually transmitted infections, such as those from Chlamydia trachomatis, Neisseria gonorrhoeae, Herpes simplex virus and Treponema pallidum. Recent outbreaks of lymphogranuloma venereum among homosexual men throughout Europe highlight the need to consider sexually transmitted infections in the differential diagnosis of proctitis, according to the study by the University of Florence(23).
2. Procitis associated with chlamydial infection
According to the University of Sydney, New South Wales. an aged koala presented for euthanasia was found to have asymptomatic chronic proctitis, cystitis, prostatitis, urethritis and conjunctivitis associated with chlamydial infection. Inflammation was severe in the terminal rectum and extended into the proximal common vestibule. Chlamydial organisms were visualised in the rectal surface epithelium using Giminez’ stain and an immunoperoxidase staining method. Organisms were also detected in the epithelium of the bladder, prostate and urethra(24). Other in the study to investigate the prevalence and genotype distribution of Chlamydia trachomatis infection among men who have sex with men (MSM), 145 MSM from two sauna settings in Shenzhen, China were invited to participate in this study during September 2008 and May 2009, showed that the prevalence of anorectal chlamydial infection was 24% in the study population and was significantly associated with proctitis symptoms(25).
3. Human immunodeficiency virus infection
There is a report of a of published cases and a recently managed patient is presented, which describes the clinical features of cytomegalovirus proctitis. About half of the reports describe sexually transmitted cytomegalovirus proctitis following anal intercourse, which typically presents with rectal bleeding and a mononucleosis-like syndrome. This condition resolves spontaneously and may be associated with human immunodeficiency virus infection(26).
4. Immune-mediated diseases
In the study to to evaluate the prevalence of pANCA expression and its association with clinical findings and disease course in Korean patients with UC, included 484 patients with UC who were diagnosed and treated between 1990 and 2006 at Severance Hospital, Yonsei University, Seoul, Korea, showed that the prevalence of pANCA expression in Korean patients with UC was relatively low compared to that in Western countries. Although UC patients with pANCA expression had more severe clinical findings at diagnosis and higher cumulative relapse rates in our study, further prospective studies are warranted to clarify whether pANCA positivity influences the initial clinical presentation or disease aggressiveness(27).
5. Hermansky Pudlak syndrome
Hermansky-Pudlak syndrome (HPS) is a rare autosomal recessive disorder consisting of oculocutaneous albinism, platelet dysfunction and systemic complications associated with lipofuscin deposition in the reticuloendothelial system. According to Auxilio Mutuo Hospital, Rio Piedras, there is a report of a series of two patients with HPS treated in Puerto Rico, and the results from medical and surgical intervention for gastrointestinal disease. Our experience with HPS patients has shown the difficult management of perineal disease similar in the management of Crohn’s. However, complications from the bleeding diathesis necessitate caution during surgery and potential anesthesia complications(28).
6. Crohn’s disease
There is a report of four patients with Crohn’s disease who underwent fecal diversion with an in situ rectum were observed in whom sigmoidoscopy was initially normal at the time of the diversion, became distinctly abnormal during the year after the diversion, and then returned to normal within 3 mo following reestablishment of intestinal continuity. The entity of nonspecific diversion proctitis might account for this phenomenon independently or by accelerating the Crohn’s disease process, according to the study(29).
7. Etc.
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l Sources
(23) http://www.ncbi.nlm.nih.gov/pubmed/23007214
(24) http://www.ncbi.nlm.nih.gov/pubmed/8894023
(25) http://www.ncbi.nlm.nih.gov/pubmed/21519129
(26) http://www.ncbi.nlm.nih.gov/pubmed/21844745
(27) http://www.ncbi.nlm.nih.gov/pubmed/19507028
(28) http://www.ncbi.nlm.nih.gov/pubmed/18763399
(29) http://www.ncbi.nlm.nih.gov/pubmed/6745620