How to Cure Proctitis

Proctitis
Proctitis is the inflammation of the rectal mucosa, which may result from infection, inflammatory bowel disease, or radiation.
Symptoms are rectal discomfort and bleeding.
Diagnosis is by sigmoidoscopy, usually with cultures and biopsy. Treatment depends on etiology.

Proctitis may be manifestation of sexually transmitted diseases, certain enteric infections (e.g Campylobacter, shigella, salmonella) , inflammatory bowel disease, or radiation treatments ,it may be associated with prior antibiotic use.

Sexually transmitted pathogens produce proctitis more commonly in homosexual males. Immunocompromised patients are at particular risk for infections with herpes simplex and cytomegalovirus.

Syamptoms, Signs, Diagnosis.
Typically patients report rectal bleeding or passage of mucus. Proctitis resulting from gonorrhea, herpes simplex , or cytomegalovirus may cause intense anorectal pain.

Diagnosis requires proctoscopy or sigmoidoscopy , which may reveal an inflamed rectal mucosa.
Small discrete ulcers and vesicles suggest herpes infection.

Smears should be sent for culture of neisseria gonorrhoeae, Chlamydia sp, enteric pathogens, and viral pathogens.

Serologic tests for syphilis and stool tests for clostridium difficile toxin are performed. Sometimes mucosal biopsy is needed .
Colonoscopy may be valuable in some patients.

Treatments.
Infective patients proctitis can be treated with antibiotics.

Homosexual males with non-specific proctitis may be treated empirically with ceftriaxone 125 mg IM once ( or ciprofloxacin 500mg po bid for 7 days. Antibiotics associated with proctitis is treated with metronidazole (250 mg po qid) or vancomycin (125 mg po qid) for 7 to 10 days.

Radiation proctitis is usually effectively treated with topical formalin carefully applied to the affected mucosa. Altenative treatment include topical corticosteroids as foam (hydrocortisone 90 mg) or enemas (hydrocortisone 100 mg or methylpredinisolone 40 mg ) bid for 3 wk, or mesalamine (4g) enema at bedtime for 3 to 6 wk.

Mesalamine suppositories 500 mg once per day or bid , mesalamine 800 mg po tid , or sulfasalazine 500 mg to 1000mg po qid for > = 3 wk alone or in combination with topical therapy may also be effective.
Patients unresponsive to these forms of therapy may benefit from course of systemic corticosteroids.

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