Ulcerative proctitis: a review of pharmacotherapy and management

BACKGROUND: Ulcerative proctitis (UP) is a common presentation of ulcerative colitis (UC). OBJECTIVE: To summarize available literature on up-to-date management and pharmacotherapy of UP patients. METHODS: Extensive Medline/Embase literature search was performed to identify relevant articles. RESULTS/CONCLUSION: Topical medication with rectally administered 5-aminosalicylic acid (5-ASA)/corticosteroid suppositories or enemas is effective treatment for most UP patients. Locally administered 5-ASA is more efficacious than oral compounds. The combination of topical 5-ASA and oral 5-ASA or topical steroids should be considered for escalation of treatment. Maintenance treatment is indicated in all UC cases. 5-ASA suppositories are suggested as first-line maintenance therapy if accepted by patients, although oral 5-ASA as maintenance therapy might prevent proximal extension of the disease. After re-assessment, chronically active patients refractory or intolerant to 5-ASAs and corticosteroids may require immunomodulators or biological therapy. Exceptional cases may require a proctocolectomy.