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Wednesday, 4 December 2013

Proctitis – The Risk Factors

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. Rick factors
1. Low abdominal pain, high inflammatory lesions and an family history
According to the study by Hôpital Pontchaillou, of the Endoscopic information obtained for 52 patients with ulcerative proctitis (23 F, 29 H) seen during a ten-year period. The median follow-up was 68 +/- 8 months, showed that low abdominal pain, an family history of ulcerative colitis, and high inflammatory lesions at referral were significantly associated with a higher risk of extension(5).
2. Young age of onset of symptoms, smoking and appendectomy
According to the study of “Course and natural history of idiopathic ulcerative proctitis in adults” by Università degli Studi di Brescia Cattedra di Chirurgia Generale, Young age of onset of symptoms, smoking and appendectomy are associated with an increased risk of extension of the disease(6).
3. Sexual behavior(7)
a. Men having sex with men (MSM)
Sexually transmitted infection (STI) screening programmes are implemented in many countries to decrease burden of STI and to improve sexual health. In a study of a total of 1455 consultations in MSM showed that the prevalence of C. trachomatis and N. gonorrhoeae per anatomic site was: urethral infection 4.0% respectively and 2.8%, oropharynx 1.5% and 4.2%, and anorectum 8.2% and 6.0%. The majority of chlamydia cases (72%) involved a single anatomic site, which was especially manifest for anorectal infections (79%), while 42% of gonorrhoea cases were single site. Twenty-six percent of MSM with anorectal chlamydia and 17% with anorectal gonorrhoea reported symptoms of proctitis; none of the oropharyngeal infections were symptomatic. Most cases of anorectal infection (83%) and oropharyngeal infection (100%) would have remained undiagnosed with a symptom-based protocol.
b. Others
If you have multiple partners, , don’t use condoms and have sex with a partner who has an STI, you are as an increased risk to develop proctitis.
4. Inflammatory bowel diseases
Risk of proctitis is increased with patient with IBD. In the study of a total of 1,255 filled questionnaires received with 96 were rejected and 1,159 (92.3 %), this comprised data on 745 (64.3 %) patients with UC, 409 (35.3 %) with CD, and 5 with indeterminate colitis. The median duration of illness was longer in patients with CD (48 months) compared to those with UC (24 months) (p = 0.002), found that more than one half of patients (UC 51.6 %, CD 56.9 %) had one or more extraintestinal symptoms. A definite family history of IBD was present in 2.9 % (UC 2.3 % and CD 4.6 %; p = 0.12). The extent of disease in UC was pancolitis 42.8 %, left-sided colitis 38.8 %, and proctitis alone in 18.3 %(8).
5. Cancer radiation therapy
According to the study by the University of Minnesota Hospital and Clinics, a high posterior rectal dose (> 5,000 cGy) is associated with increased prevalence of proctitis after radiation therapy(9).
6. Socioeconomic factors, dietary and other personal habits, and medical history
In the study of the risk factors for extensive ulcerative colitis and ulcerative proctitis of a total of 167 (98%) of all prevalent cases of ulcerative colitis diagnosed in Uppsala county from 1945 to 1964 and 167 age and sex matched population, showed that ulcerative colitis patients were less likely than controls to be current cigarette, pipe, or cigar smokers (odds ratio (OR) = 0.44; 95% confidence limits (CL) = 0.25-0.78), but more likely to have symptoms induced by drinking milk (OR = 4.63; 95% CL = 2.15-9.93). Patients with ulcerative colitis do not differ in most of the socioeconomic, dietary and personal habits compared with the background population(10).
7. Frequent fecal impactions
Frequent fecal impactions without proper treatment are associated toincreased risk of proctitis, according to the study by the Ohio University(10a).
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l Sources
(5) http://www.ncbi.nlm.nih.gov/pubmed/2060743
(6) http://www.ncbi.nlm.nih.gov/pubmed/12197289
(7) http://www.ncbi.nlm.nih.gov/pubmed/21791061
(8) http://www.ncbi.nlm.nih.gov/pubmed/23073755
(9) http://www.ncbi.nlm.nih.gov/pubmed/7753997
(10) http://www.ncbi.nlm.nih.gov/pubmed/1773960
(10a) http://www.ncbi.nlm.nih.gov/pubmed/17570316