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proctitis (rectitis)
Inflammation of the rectal mucosa.
Etiology:
1) infectious agents
a) Neisseria gonorrhoeae*
b) Treponema pallidum (syphilis) [4]
c) Chlamydia trachomatis
d) Lymphogranuloma venereum
e) Mycobacterium tuburculosis
f) cytomegalovirus (CMV)
g) with ulceration
- Herpes simplex virus (HSV)
- HIV1
- Haemophilus ducreyi (chancroid)
- Klebsiella granulomatos (granuloma inguinale)
h) proctocolitis (see enterocolitis)
2) autoimmune disease
- inflammatory bowel disease
- lumphoid follicular proctitis
- Behcet syndrome
3) trauma
- foreign bodies
- chemical proctitis
4) radiation therapy (radiation proctitis)
5) lymphoma
6) ischemia
7) amyloidosis
8) idiopathic
* most common cause in men with HIV1 infection who engage in receptive anal sex [7]
Pathology:
- radiation proctitis
- affected mucosa is frequently pale & friable
- extensive telangiectasia may be a source of bleeding
Clinical manifestations:
- tenesmus
- rectal pain
- rectal urgency
- constipation or diarrhea
- mucus discharge
- purulent or bloody discharge (rectal bleeding)
- radiation proctitis may be acute (within 6 weeks) or chronic (may occur years, even decades after radiation therapy) [6]
Special laboratory:
- colonoscopy for radiation proctitis (see radiation therapy)
- segmental distribution
- abrupt transition between injured & uninjured mucosa, correlating with the region exposed to radiation
Management:
- treat sexually transmitted disease
- empiric treatment of gonorrhea & Chlamydia with ceftriaxone & doxycycline [3]
- rectal hydrocortisone 1st line for radiation proctitis
- sucralfate enemas if failure of rectal hydrocortisone [7]
- mesalamine suppositories (Rowasa) 500 mg 1st line for ulcerative proctitis
- rectal glucocorticoid if intolerant of mesalamine
- see ulcerative proctitis
Specific
proctosigmoiditis
ulcerative proctitis
General
intestinal disease
inflammation
References
- Saunders Manual of Medical Practice, Rakel (ed),
WB Saunders, Philadelphia, 1996, pg 338
- Stedman's Medical Dictionary 26th ed, Williams &
Wilkins, Baltimore, 1995
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998
- Medical Knowledge Self Assessment Program (MKSAP) 20
American College of Physicians, Philadelphia 2025
- Zeidman JA, Shellito PC, Davis BT, Zukerberg LR
Case 25-2016 - A 33-Year-Old Man with Rectal Pain and Bleeding.
N Engl J Med 2016; 375:676-682. August 18, 2016
PMID: 27532834
http://www.nejm.org/doi/full/10.1056/NEJMcpc1602815
- Rothaus C
A Man with Rectal Pain.
Now@NEJM. Aug 18, 2016
http://blogs.nejm.org/now/index.php/man-rectal-pain/2016/08/18/
- Porouhan P, Farshchian N, Dayani M.
Management of radiation-induced proctitis.
J Family Med Prim Care. 2019 Jul;8(7):2173-2178.
PMID: 31463226 PMCID: PMC6691413 Free PMC article
- NEJM Knowledge+ Gastroenterology
- Proctitis
https://www.niddk.nih.gov/health-information/digestive-diseases/proctitis