Holistic Health Articles and Research Related to Herbal Medicines, Foods and Phytochemicals

Thursday, 5 December 2013

Proctitis – Ulcerative proctitis Treatments In conventional medicine perspective

Proctitis – Ischemic proctitis Treatments In conventional medicine perspective

Proctitis is 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.
VI. Treatments
A. In conventional medicine perspective
Medical treatment of proctitis depends on the etiology
A.2. Ischemic proctitis
A.2.1. Acute ischemic proctitis
1. Non surgical interventions, include
a. Superficial mucosal ischemia
Superficial mucosal ischemia was treated without surgery, but deeper levels of necrosis required laparotomy and Hartmann’s resection. Rectal excision was not necessary. Four patients survived the ischemic event(67).
b. Formalin instillation
Topical (4 percent) formalin is safe and effective in treatment of radiation-induced hemorrhagic proctitis. A single treatment will stop bleeding in 75 percent of patients(68). Other study also indicated that there is a case of an elderly male with multiple medical problems and hemorrhagic, ischemic proctitis is presented. The proctitis was refractory to all other medical options but responded to topical instillation of 4 percent formalin(69).
2. Surgical interventions include
a. Proctectomy
There is a report of four cases of acute ischemic proctitis that required complete proctectomy. All patients had large vessel atherosclerosis with rectal bleeding and sepsis as the presenting signs and symptoms. Three of four patients underwent complete proctectomy as the initial procedure. The fourth patient underwent complete proctectomy five days after the initial intervention. Two of four patients survived and were ultimately discharged from the hospital. A third patient recovered from surgery but ultimately died of respiratory complications. Only the patient who was initially treated by subtotal proctectomy died as the result of the disease. Although ischemic necrosis of the rectum is rare, complete proctectomy may be necessary to save the patient’s life(70).
b. Transcatheter embolization
In the study of treatment of lower gastrointestinal bleeding was attempted in 13 patients by selective embolization of branches of the mesenteric arteries with Gelfoam, showed that One patient improved after embolization but bleeding recurred within 24 hours and in another patient the catheterization was unsuccessful. Five patients with diverticular hemorrhage were embolized in the right colic artery four times, and once in the middle colic artery. Three patients had embolization of the ileocolic artery because of hemorrhage from cecal angiodysplasia, post appendectomy, and leukemia infiltration. Three patients had the superior hemorrhoidal artery embolized because of bleeding from unspecific proctitis, infiltration of the rectum from a carcinoma of the bladder, and transendoscopic polypectomy(71).
A.2.2. Chronic ischemic proctitis
1. Non surgical treatments
In the study to identify the various non-surgical treatment options for the management of late chronic radiation proctitis and evaluate the evidence for their efficacy, showed that Sixty-three studies met the inclusion criteria, including six randomised controlled trials that described the effects of anti-inflammatory agents in combination, rectal steroids alone, rectal sucralfate, short chain fatty acid enemas and different types of thermal therapy(72).
2. Surgical interventions include
1. Laparoscopic colorectal surgery
In the study to assess the outcome of laparoscopic colorectal surgery in patients >60 years of age and compare it to a younger group of patients who underwent similar procedures, indicated that here were no statistically significant differences between the younger and older groups relative to the incidence of complications (11 vs 14%, respectively) and conversion (8 vs 11%, respectively) or the length of ileus (2.8 vs 4.2 days, respectively) or hospitalization (5.2 vs 6.5 days, respectively) (P = NS for all). There was no mortality in either group. The outcome of laparoscopic colorectal surgery in older patients is similar to that noted in younger patients. Advanced age should not be a contraindication to laparoscopic colorectal surgery(73).
2. Laparoscopic or laparoscopic-assisted colorectal operations
There were 140 laparoscopic and laparoscopic-assisted procedures performed between May 1991 and January 1995. The mean patient age was 48 (range 12-88) years; there were 78 males and 62 females. Indications for surgery included inflammatory bowel disease in 47, colorectal carcinoma in 19, diverticular disease in 17, polyps in 16, familial polyposis in 7, colonic inertia in 7, fecal incontinence in 11, sigmoidocele in 3, irradiation proctitis in 3, rectal prolapse in 2, intestinal lymphoma in 2, and miscellaneous conditions in 6. The procedures included 38 total abdominal colectomies (TAC) (ileoanal reservoir 28, ileorectal anastomosis 8 and end ileostomy 2); 70 segmental resections of the colon, small bowel, and rectum(74)
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Sources
(67) http://www.ncbi.nlm.nih.gov/pubmed/1582361
(68) http://www.ncbi.nlm.nih.gov/pubmed/8620787
(69) http://www.ncbi.nlm.nih.gov/pubmed/10696902
(70) http://www.ncbi.nlm.nih.gov/pubmed/17160570
(71) http://www.ncbi.nlm.nih.gov/pubmed/2958057
(72) http://www.ncbi.nlm.nih.gov/pubmed/12107832
(73) http://www.ncbi.nlm.nih.gov/pubmed/8955249
(74) http://www.ncbi.nlm.nih.gov/pubmed/8932614

Proctitis Treatments – Radiation proctitis In conventional medicine perspective

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.
VI. Treatments
A. In conventional medicine perspective
Medical treatment of proctitis depends on the etiology
A.1. Radiation proctitis
A.1.1. Acute radiation proctitis
Acute radiation proctitis usually does not require treatment as the diseases can resolve after several months. Topical mesalazine is contraindicated during radiotherapy. Hydrocortisone enema is not superior to sucralfate in preventing acute rectal toxicity.. According to the study to assess whether the topical use of steroids or 5-aminosalicylic acid (5-ASA) is superior to sucralfate in preventing acute rectal toxicity during three-dimensional conformal radiotherapy (3DCRT) to 76 Gy(63),
A.1.2. Chronic radiation proctitis
Chronic radiation proctitis is the result of damage to the blood vessels which supply the colon due to radiotherapy.
1. Non surgical interventions
Chronic radiation proctitis (inflammation of the rectum) may develop after the completion of pelvic radiotherapy. In Studies (preferentially randomised controlled trials) of interventions for the non-surgical management of late radiation proctitis in patients who have undergone pelvic radiotherapy as part of their cancer treatment, indicated that Late radiation complications are a relatively rare manifestation, with many potential carers and poor diagnostic criteria. Although certain interventions look promising and may be effective (such as rectal sucralfate, adding metronidazole to the anti-inflammatory regime and heater probes), single small studies (even if well conducted) provide insufficient evidence(64).
2. Surgical interventions
a. Cryospray Ablation
Radiation proctitis, a common condition associated with radiotherapy for the treatment of pelvic cancers, is characterized by difficult to manage rectal pain and bleeding. According to the study by the Uniformed Services University of the Health Sciences, Cryotherapy is an effective method in the management of chronic radiation proctitis with minimal complications(65).
b. Radio frequency ablation (RFA)
Radiation proctitis is a frequent complication of pelvic radiation for cancer. There is a report of a case of refractory radiation proctitis, with suboptimal response to other therapies, treated successfully with a novel method, radiofrequency ablation(66).
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(63) http://www.ncbi.nlm.nih.gov/pubmed/12835883
(64) http://www.ncbi.nlm.nih.gov/pubmed/11869662
(65) http://www.ncbi.nlm.nih.gov/pubmed/23362977
(66) http://www.ncbi.nlm.nih.gov/pubmed/23320051

Proctitis Preventions – The Phytochemicals and antioxidants

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.
VI. Preventions
B. Phytochemicals and antioxidants to prevent Proctitis
1. Theaflavin-3-gallate
Theaflavin-3-gallate, a theaflavin derivative, is phytochemicals of Flavan-3-ols, in the group of Flavonoids (polyphenols) found abundantly in black tea. In the comparison of TF derivatives (theaflavin (TF(1)), theaflavin-3-gallate (TF(2)A), theaflavin-3′-gallate (TF(2)B), and theaflavin-3,3′-digallate (TF(3))) in scavenging reactive oxygen species (ROS) in vitro, indicated that positive antioxidant capacities of TF(2)B on singlet oxygen, hydrogen peroxide, hydroxyl radical, and the hydroxyl radical-induced DNA damage in vitro were found, according to “Evaluation of the antioxidant effects of four main theaflavin derivatives through chemiluminescence and DNA damage analyses” by Wu YY, Li W, Xu Y, Jin EH, Tu Y(43).
Other In the evaluation of the antimicrobial activities of seven green tea catechins and four black tea theaflavins, found that (-)-gallocatechin-3-gallate, (-)-epigallocatechin-3-gallate, (-)-catechin-3-gallate, (-)-epicatechin-3-gallate, theaflavin-3, 3′-digallate, theaflavin-3′-gallate, and theaflavin-3-gallate showed antimicrobial activities at nanomolar levels; (ii) most compounds were more active than were medicinal antibiotics, such as tetracycline or vancomycin, at comparable concentrations; (iii) the bactericidal activities of the teas could be accounted for by the levels of catechins and theaflavins as determined by high-pressure liquid chromatography; (iv) freshly prepared tea infusions were more active than day-old teas; and (v) tea catechins without gallate side chains, gallic acid and the alkaloids caffeine and theobromine also present in teas, and herbal (chamomile and peppermint) teas that contain no flavonoids are all inactive, according to “Antimicrobial activities of tea catechins and theaflavins and tea extracts against Bacillus cereus” by Friedman M, Henika PR, Levin CE, Mandrell RE, Kozukue N(44).
2. Allyl sulfides
Garlic has been used in traditional Chinese and herbal medicine over thousands of year as antibacterial, antiviral, and antifungal agent and in treating other conditions such as parasites, respiratory problems, poor digestion, low energy, etc. In many studies, researchers found that Allyl sulfides, a phytochemical in garlic has been demonstrated effectively in treating certain diseases.
According to the article of “GARLICTHE BOUNTIFUL BULB” by Carmia Borek, Ph.D. posted in Life extension magazine, the author indicated that human studies confirm immune stimulation by garlic. Subjects receiving aged garlic extract at 1800 mg a day for three weeks showed a 155.5% increase in natural killer immune cell activity that kills invaders and cancer cells. Other subjects receiving large amounts of fresh garlic of 35g a day, equivalent to 10 cloves, showed an increase of 139.9%. In six weeks, patients with AIDS receiving aged garlic extract showed an enhancement of natural killer cells from a seriously low level to a normal level.
3. Piperine
Piperine is a phytochemical alkaloid in the class of organosulfur compound, found abundantly in white and black pepper, long pepper, etc. In the valuation of novel synthetic analogues of piperine as inhibitors of multidrug efflux pump NorA of Staphylococcus aureus, showed that a newly identified class of compounds derived from a natural amide, piperine, is more potent than the parent molecule in potentiating the activity of ciprofloxacin through the inhibition of the NorA efflux pump. These molecules may prove useful in augmenting the antibacterial activities of fluoroquinolones in a clinical setting, according to “Novel structural analogues of piperine as inhibitors of the NorA efflux pump of Staphylococcus aureus” by Ashwani Kumar, Inshad Ali Khan, Surrinder Koul, Jawahir Lal Koul, Subhash Chandra Taneja, Intzar Ali, Furqan Ali, Sandeep Sharma, Zahid Mehmood Mirza, Manoj Kumar, Pyare Lal Sangwan, Pankaj Gupta, Niranjan Thota and Ghulam Nabi Qazi(45)
Other In the investigation of investigate the anti-inflammatory effect of piperine against adjuvant-induced arthritis in rats, an experimental model for rheumatoid arthritis and compared it with that of the non-steroidal anti-inflammatory drug indomethacin, found that Histopathological analysis of joints also revealed that synovial hyperplasia and mononuclear infiltration observed in arthritic rats were alleviated by piperine. Thus, the present study clearly indicated that piperine possesses promising anti-inflammatory effect against adjuvant-induced arthritis by suppressing inflammation and cartilage destruction, according to “Anti-inflammatory Effect of Piperine in Adjuvant-Induced Arthritic Rats-a Biochemical Approach” by Murunikkara V, Pragasam SJ, Kodandaraman G, Sabina EP, Rasool M(46).
4. Sinigrin
Sinigrin is a phytochemical glucosinolate, belongs to the family of glucosides found abundantly in Brussels sprouts, broccoli, the seeds of black mustard, etc. In the investigation of Allyl isothiocyanate (AIT) derived from the glucosinolate sinigrin found in plants of the family Brassicaceae and its antimicrobial agent against a variety of organisms, including foodborne pathogens such as Escherichia coli O157:H7, found that it can be postulated that: 1) AIT is a more effective antimicrobial at low pH values and its degradation reduces this activity; 2) decomposition products in water might not participate in the antimicrobial action of AIT; and 3) AIT seems to have a multi-targeted mechanism of action, perhaps inhibiting several metabolic pathways and damaging cellular structures, according to “Enzymatic inhibition by allyl isothiocyanate and factors affecting its antimicrobial action against Escherichia coli O157:H7″ by Luciano FB, Holley RA(47).
Other In the examination of the effect of an aqueous extract of cooked Brussels sprouts on formation of 7-hydro-8-oxo-2′-deoxyguanosine (8-oxodG) in calf thymus DNA in vitro, found that Sinigrin, a glucosinolate abundant in Brussels sprouts, co-eluted with the most effective fraction and had DNA protective effects. In comparison with other antioxidants the patterns of effect of the extract in the five damage systems were more similar to that of sodium azide than to those of dimethylsulfoxide and vitamin C, according to “Inhibition of oxidative DNA damage in vitro by extracts of brussels sprouts” by Zhu C, Poulsen HE, Loft S(48).
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(43) http://www.ncbi.nlm.nih.gov/pubmed/21887850
(44) http://www.ncbi.nlm.nih.gov/pubmed/16496576
(45) http://jac.oxfordjournals.org/content/61/6/1270.full
(46) http://www.ncbi.nlm.nih.gov/pubmed/22389056
(47) http://www.ncbi.nlm.nih.gov/pubmed/19346022
(48) http://www.ncbi.nlm.nih.gov/pubmed/10885626

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All rights reserved. Any reproducing of this article must have the author name and all the links intact. "Let Take Care Your Health, Your Health Will Take Care You" Kyle J. Norton I have been studying natural remedies for disease prevention for over 20 years and working as a financial consultant since 1990. Master degree in Mathematics, teaching and tutoring math at colleges and universities before joining insurance industries. Part time Health, Insurance and Entertainment Article Writer.

Proctitis Preventions – The Diet

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.
VI. Preventions
A. Diet to prevent Proctitis
1. Black and green tea
Gallocatechin, containing catechin is phytochemicals of Flavan-3-ols, in the group of Flavonoids (polyphenols), found abundantly in green and black tea. In the evaluation of the anti-inflammatory and antimicrobial effect of nanocatechin on CBP and plasma concentration of catechins in an animal model, found that the use of ciprofloxacin, catechin, and nanocatechin showed statistically significant decrease in bacterial growth and improvement in prostatic inflammation compared with the control group. The nanocatechin group showed statistically significant decrease in bacterial growth and improvement in prostatic inflammation compared with the catechin group. Plasma concentrations of epicatechin, gallocatechin gallate, and epigallocatechin gallate were significantly higher in the nanocatechin group than those in the catechin group. These results suggest that nanocatechin has better antimicrobial and anti-inflammatory effects on rat CBP than catechin due to higher absorption into the body, according to “Anti-inflammatory and antimicrobial effects of nanocatechin in a chronic bacterial prostatitis rat model” by Yoon BI, Ha US, Sohn DW, Lee SJ, Kim HW, Han CH, Lee CB, Cho YH(38).
Other In the identification of tea polyphenols for their ability to inhibit enterovirus 71 (EV71) replication in Vero cell culture, found that The viral inhibitory effect correlated well with the antioxidant capacity of polyphenol. Mechanistically, EV71 infection led to increased oxidative stress, as shown by increased dichlorofluorescein and MitoSOX Red fluorescence. Upon EGCG treatment, reactive oxygen species (ROS) generation was significantly reduced. Consistent with this, EV71 replication was enhanced in glucose-6-phosphate dehydrogenase deficient cells, and such enhancement was largely reversed by EGCG, according to “Antiviral effect of epigallocatechin gallate on enterovirus 71″ by Ho HY, Cheng ML, Weng SF, Leu YL, Chiu DT(39).
2. Apple skin
Quercetin is a member of flavonoids, found abundantly in apple skin It is also one of antioxidants with property of protecting our body in fighting against forming of free radicals cause of mutation of cells`DNA. According to the study of `Antimicrobial and cytotoxic activities of leaves, twigs and stem bark of Scutia buxifolia Reissek.`by Boligon AA, Janovik V, Frohlich JK, Spader TB, Forbrig Froeder AL, Alves SH, Athayde ML. (Source from a Phytochemical Research Laboratory, Department of Industrial Pharmacy , Federal University of Santa Maria , Build 26, room 1115 , Santa Maria , CEP 97105-900 , Brazil.), posted in PubMed, researchers found that quercitrin, isoquercitrin and rutin were identified by HPLC and may be partially responsible for the antimicrobial activities observed. This study reports for the first time the antimicrobial and cytotoxic activities of S. buxifolia leaves, twigs and stem bark.
Also according to the study of `Antioxidant and Anti-Inflammatory Activities of Quercetin 7-O-β-D-Glucopyranoside from the Leaves of Brasenia schreberi.`by Legault J, Perron T, Mshvildadze V, Girard-Lalancette K, Perron S, Laprise C, Sirois P, Pichette A. (Source from Laboratory for Analysis and Separation of Plant Species (LASEVE), Université du Québec à Chicoutimi , Chicoutimi, Québec, Canada.), posted in PubMed, researchers found that some flavonoids have been reported to possess beneficial effects in cardiovascular and chronic inflammatory diseases associated with overproduction of nitric oxide. Quercetin-7-O-β-D-glucopyranoside possesses anti-inflammatory activity, inhibiting expression of inducible nitric oxide synthase and release of nitric oxide by lipopolysaccharide-stimulated RAW 264.7 macrophages in a dose-dependent manner. Quercetin-7-O-β-D-glucopyranoside also inhibited overexpression of cyclooxygenase-2 and granulocyte macrophage-colony-stimulating factor.
3. Tomatoes
Tomato is a red, edible fruit, genus Solanum, belongs to family Solanaceae, native to South America. Because of its health benefits, tomato is grown world wide for commercial purpose
and often in green house. Tomato is considered as antiseptic natural foods including natural antiseptic agent ascorbic acid that helps to enhance the immune system in guarding our body against the possibility of infection, sepsis, or putrefaction, according to the article of “The 7 Benefits Of Drinking Lemon Water” posted in Simple Health Cures. Other study indicated that Lycopene, one of the powerful antioxidant in tomatoes, not only helps the immune system in neutralizing the forming of free radicals in the body and according to Harvard investigation as it found that men who ate more than 10 servings tomato-based foods daily (like cooked tomatoes and tomato sauce,) had a 35 percent lower risk of developing prostate cancer than those who ate the least amount of these foods. The benefits of lycopene was more pronounced with advanced stages of prostate cancer. Also according to the study of “Chemoprevention of prostate cancer with lycopene in the TRAMP model” by Konijeti R, Henning S, Moro A, Sheikh A, Elashoff D, Shapiro A, Ku M, Said JW, Heber D, Cohen P, Aronson WJ., posted in PubMed(40)
4. Fennel
Fennel is a species of Foeniculum Vulgare, belong to the family Apiaceae (Umbelliferae), and native to to the shores of the Mediterranean. It is now widely cultivated all around the globe to use as food and herb. In the determination of the chemical compositions of the essential oil and hexane extract isolated from the inflorescence, leaf stems, and aerial parts of Florence fennel found that the essential oil, anethole, and hexane extract were effective against most of the foodborne pathogenic, saprophytic, probiotic, and mycotoxigenic microorganisms tested. The results of the present study revealed that (E)-anethole, the main component of Florence fennel essential oil, is responsible for the antimicrobial activity , according to “Antimicrobial activities of essential oil and hexane extract of Florence fennel [Foeniculum vulgare var. azoricum (Mill.) Thell.] against foodborne microorganisms” by Cetin B, Ozer H, Cakir A, Polat T, Dursun A, Mete E, Oztürk E, Ekinci M(41).
Other In the study of fennel honey, ethanol, and aqueous propolis extracts orally and theirs effect on immune defense found that all tested previously bee product-immunized rats could significantly challenge the induced S. aureus infection (P < .01). The effects were more pronounced in rats that had received fennel honey solution, according to "Immune defense of rats immunized with fennel honey, propolis, and bee venom against induced staphylococcal infection" by Sayed SM, Abou El-Ella GA, Wahba NM, El Nisr NA, Raddad K, Abd El Rahman MF, Abd El Hafeez MM, Abd El Fattah Aamer A(42).
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Sources (38) http://www.ncbi.nlm.nih.gov/pubmed/20694569
(39) http://www.ncbi.nlm.nih.gov/pubmed/21903153
(40) http://www.ncbi.nlm.nih.gov/pubmed/20687227
(41) http://www.ncbi.nlm.nih.gov/pubmed/20136455
(42) http://www.ncbi.nlm.nih.gov/pubmed/19627205

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Proctitis -The Diagnosis

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. Diagnosis
1. Stool sample
The aim of the stool examination is to find out types of bacterial causes of infection.
Unfornunately, Non-invasive diagnostic tools to evaluate the severity of acute, radiation-induced proctitis are not readily available, but faecal calprotectin and lactoferrin concentrations could be markers of acute, radiation-induced proctitis(34).
2. Blood test
The aim of the blood test is also to determine the types of infection as well as blood loss
3. Proctoscopy
Proctoscopy procedure in which yuor doctor insert a thin tube containing a camera and a light to visually inspect to look for sign of proctitis. In a prospective study of 130 patients who underwent external radiation therapy (RT) for stage T1 to T4 prostate cancer between 1997 and 2008, to determine the Role of Early Proctoscopy in Predicting Late Symptomatic Proctitis After External Radiation Therapy for Prostate Carcinoma, Proctoscopy showed that In patients with acute endoscopic proctitis (AEP) and Acute clinical proctitis (ACP), the risk of late clinical proctitis (LCP) was more than 5-fold increased compared to those who were asymptomatic, while a much smaller increase in risk occurred in patients with ACP only. Early proctoscopy can provide valuable information regarding the likelihood of late(35).
4. Rectal culture
Rectal culture is the laboratory test of normally involves a swab of patients rectum with an aim to determine types of bacterial causes of proctitis.
5. Rectal microscopy
The Microstructure imaging of human rectal mucosa may be helpful in determination the causes of the disease. According to the study by the Urinary Medicine, Mortimer Market Centre, in all, 134/136 had rectal microscopy of whom, 47/134 (35%) were smear-positive for Rectal gonorrhoea (GC) . Of the 136 cases, 90 received antibiotics for GC at their first presentation. Twenty-four of 90 (27%) would not have been treated until culture results were available, if rectal microscopy had not been performed. The results suggest that rectal microscopy remains an important tool and increases the proportion of men treated for GC at their first attendance(36).
6. Sigmoidoscopy
Sigmoidoscopy is a procedure of using a flexible tube called a sigmoidoscope with a small camera attached to the end placed through the anus and gently moved into your colon for examination of up to the sigmoid. Dr. McMillan A. in the study to to assess the value of sigmoidoscopy in the routine investigation of homosexual men, this procedure was undertaken on 1118 men who attended a sexually transmitted diseases clinic as “new” or “return new” patients, indicated that Serious rectal disease was not identified in any of the 557 men who were symptomless at the initial attendance. Though the extent of the proctitis diagnosed in 166 men would not have been defined, 99% (465) of 470 anorectal lesions would have been identified if proctoscopy alone had been performed. It is concluded that sigmoidoscopy does not have a role in the routine investigation of homosexual men(37).
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(34) http://www.ncbi.nlm.nih.gov/pubmed/15545170
(35) http://www.ncbi.nlm.nih.gov/pubmed/22975612
(36)_ http://www.ncbi.nlm.nih.gov/pubmed/16595053
(37) http://www.ncbi.nlm.nih.gov/pubmed/3817825

Proctitis – Misdiagnosis

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.
A. Misdiagnosis
1. Hirschsprung’s disease
Allergic proctitis and abdominal distention mimicking Hirschsprung’s disease in infants.In the study to determine the incidence and clinical aspects of allergic proctitis (AP) in infants with symptoms that mimic Hirschsprung’s disease (HD), found that in the infants with severe abdominal distention, the incidence of AP mimicking HD was relatively high. Therefore, consideration of AP should be part of the differential diagnosis in infants with severe abdominal distention or findings that mimic HD. For differentiation of these disorders, a rectal suction biopsy is very useful.In the infants with severe abdominal distention, the incidence of AP mimicking HD was relatively high. Therefore, consideration of AP should be part of the differential diagnosis in infants with severe abdominal distention or findings that mimic HD. For differentiation of these disorders, a rectal suction biopsy is very useful(30).
2. Diffuse cavernous haemangioma of the rectum (DCHR)g masquerading
Diffuse cavernous haemangioma of the rectum (DCHR) is a rare benign vascular neoplasm that affects mainly young adults and can present with rectal bleeding or massive haemorrhage. There is a report of a case of DCHR masquerading as proctitis which was diagnosed many years ago following colonoscopy, according to St. George’s Hospital NHS Trust, London(31).
3. Colitis cystica profunda and solitary rectal ulcer syndrome-polyoid variant
Colitis cystica profunda and solitary rectal ulcer syndrome-polyoid variant are related chronic benign disorders with characteristic histological features. There is a report of a case of colitis cystica profunda and solitary rectal ulcer syndrome-polypoid variant that was misdiagnosed initially as an ulcerative proctitis, according to the study by Ben-Gurion University of the Negev, Beer-Sheva, Israel(32).
4. Rectal strictures
Rectal strictures are uncommon in young patients without a history of malignancy, inflammatory bowel disease or previous surgery. It presents with nonspecific symptoms, rectal ulcer, proctitis, anal fissures, abscesses and rectal strictures. Clinical and endoscopic findings as well as histology resemble Crohn’s disease, which may be misdiagnosed/ According to the study by King’s College Hospital, rectal lymphogranuloma venereum is a rare cause of rectal strictures but surgeons should be aware of its existence and include it in the differential diagnosis of unexplained strictures in high-risk patients(33).
5. Etc.
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(30) http://www.ncbi.nlm.nih.gov/pubmed/17953729
(31) http://www.ncbi.nlm.nih.gov/pubmed/22739216
(32) http://www.ncbi.nlm.nih.gov/pubmed/17142179
(33) http://www.ncbi.nlm.nih.gov/pubmed/9640444