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Medical Therapy of Ulcerative Proctitis and Proctosigmoiditis, Including Refractory Disease

1995; Oxford University Press; Volume: 1; Issue: 3 Linguagem: Inglês

10.1097/00054725-199509000-00007

1536-4844

Alain Bitton, Mark A. Peppercorn,

Autoimmune and Inflammatory Disorders

Ulcerative proctosigmoiditis (also commonly referred to as distal ulcerative colitis) is defined as inflammation limited to the distal 30-50 cm of colonic mucosa, whereas ulcerative proctitis refers to disease confined to the rectum. The major recent breakthrough in the therapy of these conditions has been the advent of various topical anti-inflammatory agents. These agents directly contact the inflamed mucosa and have less systemic absorption than the oral medications. The first compounds used as rectal suspensions were corticosteroid enemas. Subsequently, sulfasalazine and 5-aminosalicylate (5-ASA) enemas were studied. Oral sulfasalazine and oral mesalamine also are being utilized, although there are very few studies assessing their efficacy specifically in disease limited to the distal colon. Immunomodulators have an increasingly important role in steroid dependent and steroid refractory distal colitis, situations in which physicians may be reluctant to send patients to surgery for disease that is so limited. This review discusses the various agents utilized in the therapy for conventional and refractory ulcerative proctitis and distal colitis. It will also outline our personal approach to treating patients with these conditions. Since there is very little data on Crohn's proctitis and proctosigmoiditis, we will not discuss these entities in our review.