A. In conventional medicine perspective
Medical treatment of proctitis depends on the etiology
A.1.3. Ulcerative proctitis
1. Non surgical treatments
Ulcerative proctitis is an important and increasingly common subcategory of ulcerative colitis (UC) in which inflammation is limited to the rectum. According to the study by the McGill University Health Centre, treatment options include the oral and/or rectal 5-aminosalicylate (5-ASA) preparations. Rectal therapy delivering higher concentrations of active medication (5-ASA or glucocorticoids) directly to the inflamed mucosa while minimizing systemic absorption provides a highly effective and safe treatment. Oral glucocorticoids are indicated in patients who are resistant to or intolerant of 5-ASA therapy. Immunomodulators have an important role in individuals with glucocorticoid dependent or glucocorticoid refractory disease(75).
2. Surgical treatments
In case of severity, surgery may be necessary. According to the study by the, Severe UC is defined as more than 6 bloody stools per day and signs of systemic involvement (fever, tachycardia, anemia). These patients should be hospitalized for intensive treatment and surveillance (ECCO EL 5, RG D) as the development of a toxic megacolon and perforation is a potentially life-threatening condition. Intravenous steroids (e.g. methylprednisolone 60 mg/d or hydrocortisone 400 mg/d) remain the mainstay of conventional therapy to induce remission (ECCO EL 1b, RG D; DGVS C). Patients refractory to maximal oral treatment with prednisolone and 5-ASA can be given the tumor necrosis factor (TNF)-α blocker IFX at 5 mg/kg (ACG EL A). Nevertheless, colectomy rates are as high as 29% in patients with severe UC and who need intravenous corticosteroids. They should therefore be presented to the colorectal surgeon on the day of admission. It is crucial that gastroenterologists and surgeons provide joint daily care in order to avoid delaying the necessary surgical therapy(76).
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