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Inflammatory Proctitis

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  • • A mild form of ulcerative colitis that is limited to the rectum

    • The disease course is often self-limited

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Radiation Proctitis

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  • • Occurs in a patient with a history of radiation to the rectum

    • Disease may develop months to years after the injury

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Epidemiology

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Inflammatory Proctitis

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  • • Colonic manifestations of ulcerative colitis develop in 10% of patients

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Radiation Proctitis

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  • • Follows radiation injury

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Symptoms and Signs

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Inflammatory Proctitis

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  • • Rectal bleeding, discharge, diarrhea, and tenesmus

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Radiation Proctitis

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  • • Diarrhea, rectal bleeding, discharge, tenesmus, pain, and incontinence

    • Symptoms of late disease are secondary to strictures, fistulas, and telangiectasias

    • Patients with late disease present with the following:

    • -Recurrent urinary tract infections

      -Vaginal discharge

      -Fecal incontinence

      -Rectal bleeding

      -Changes in stool caliber

      -Constipation

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Imaging Findings

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Inflammatory Proctitis

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  • Sigmoidoscopy: Rectal mucosa is inflamed and friable, but the remainder of the colon appears normal on exam

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Radiation Proctitis

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  • • Endoscopy may reveal friable edematous mucosa, telangiectasias, or strictures and may show internal openings of fistulas

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  • • Infectious proctitis

    • Crohn disease

    • Malignancy

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Rule Out

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  • • An infectious process must be ruled out before initiating corticosteroid therapy

    • Malignancy

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  • • History and physical exam

    • Sigmoidoscopy/colonoscopy

    • Biopsies are taken at endoscopy to rule out infectious processes and Crohn disease

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When to Admit

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  • • Severe bleeding

    • Bowel obstruction

    • Bowel perforation

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Inflammatory Proctitis

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  • • Corticosteroid retention enemas are given for 2 weeks

    • If there is no response, a short course of oral corticosteroids may be given

    • Mesalamine (5-aminosalicylic acid) may be given orally or rectally in an enema or suppository

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Radiation Proctitis

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  • • Initial therapy includes bulk-forming agents, antidiarrheals, and antispasmodics

    • Topical corticosteroids, mesalamine preparations, misoprostol suppositories, and short-chain fatty acids have all been used

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Surgery

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Indications

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  • Radiation proctitis

    • -Treat late complications of radiation injury: Dilatation of strictures and laser coagulation of telangiectasias

      -Surgical success in treating fistulas to the bladder or vagina is interposition or transposition of healthy nonirradiated tissue into the field

      -Infrequently is the rectum so badly damaged that it must be removed

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Medications

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  • • Corticosteroid enema

    • Oral steroids

    • Mesalamine, oral or rectal

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Treatment Monitoring

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  • • Lack of response to appropriate therapy calls for reassessment of the patient

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Complications

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  • • Obstruction

    • Perforation

    • Hemorrhage

    • Colonic involvement in inflammatory proctitis

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