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Colorectal Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Acute reactions include the small-bowel symptoms of diarrhea and abdominal cramps, and the large-bowel effects of acute proctitis with urgency and frequency, tenesmus, and occasionally a bloody or mucous discharge. Urinary frequency and dysuria may occur. Skin erythema may be particularly troublesome in the skinfolds of the natal cleft and perineum. Acute effects occur 2–3 weeks into a course of fractionated radiotherapy, generally resolving within a few weeks of stopping the treatment.
Gastrointestinal and liver infections
Published in Michael JG Farthing, Anne B Ballinger, Drug Therapy for Gastrointestinal and Liver Diseases, 2019
Several bacterial and virus infections can affect the rectum and perianal tissues (Table 6.3). The symptoms of infective proctitis are similar to those of non-specific inflammatory bowel disease (ulcerative colitis, Crohn’s disease) and include the passage of blood and mucus, proctalgia, constipation and tenesmus. Some infections such as lymphogranuloma venereum and tuberculosis can produce Crohn’s disease-like fistula formation and anorectal strictures.
Perianal Crohn’s Disease
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Krisztina Gecse, Christianne J. Buskens
Endoscopy is used to assess luminal inflammation and to evaluate complications such as strictures and cancer. Active luminal disease, most importantly proctitis, has implications for both management and prognosis. Proctitis is associated with problematic wound healing and high proctectomy rate (29% to 77.6%) and is a predictive factor of persistent non-healed fistula tracts.41,42 Therefore, active luminal disease confines surgical treatment to abscess drainage and non-cutting seton placement if appropriate and mandates aggressive medical therapy.42
Potential applications of drug delivery technologies against radiation enteritis
Published in Expert Opinion on Drug Delivery, 2023
Dongdong Liu, Meng Wei, Wenrui Yan, Hua Xie, Yingbao Sun, Bochuan Yuan, Yiguang Jin
Radiation proctitis is the most common clinical adverse reaction for patients receiving radiotherapy as part of the standard course of treatment for ovarian, prostate, and colon cancers. Preventive treatment protects the gastrointestinal tract from the deleterious effects of radiation therapy, improving the quality of patient life. Rectal administration is preferred due to the direct drug delivery to the lesion site of the rectum, increasing the concentration of drugs to alleviate the symptoms of radiation proctitis. Glycosaminoglycan (GAG), a highly anionic polysaccharide prepared by chemical sulfation of HA, has anti-inflammatory properties but a short retention time in the gut. Silk elastin-like protein polymers (SELPs) and semi-synthetic GAG composite rectal in situ injectable gels were prepared, which were temperature sensitive with liquid injection and converted to a solid hydrogel at the rectum. The residence time of GAG increased at the rectum, facilitating its diffusion into the rectal lumen. The hydrogel remarkably alleviated the radiation-induced abdominal pain of mice. It is a promising prevention and treatment of radiation proctitis (Figure 3) [119].
Progression risk factors of ulcerative proctitis
Published in Scandinavian Journal of Gastroenterology, 2022
Katarzyna Gaweł, Krzysztof Dąbkowski, Iwona Zawada, Teresa Starzyńska
At the time of diagnosis, in 25–55% of patients with UC the inflammatory lesions are limited to the rectum, in 17% of patients they are limited to the left side of the colon, and in 37% of patients there are extensive inflammatory lesions involving the entire colon (pancolitis). Moreover, epidemiological studies have shown that in recent years the incidence of proctitis has increased, while the incidence of more extensive inflammatory lesions has remained steady [1,2]. According to data from 2021, proctitis is found in 30–60% of patients, whereas left-sided colitis is observed in 16–45% and pancolitis in 14–35% [16]. Even though proctitis affects only a short section of the large intestine and the disease is usually mild, some patients may experience moderate or severe symptoms. Although the clinical characteristics and prognostic factors of UC have been studied for many years, data on risk factors of disease progression in UP are still scarce. However, it is known that the clinical picture at the onset of the disease and its subsequent course differ from patient to patient. The disease is characterized by a chronic course and in most patients there are periods of aggravations and remissions, but in some patients symptoms may be continuous [9,17,18].
An update on treatment of ulcerative colitis
Published in Expert Opinion on Orphan Drugs, 2019
Proctitis may be resistant to treatment to 5-ASA even in combination therapy (oral plus topical) therefore, after assessing adherence, therapy may be escalated to oral corticosteroids combined with oral and topical 5-ASA. Patients who fail these regimen have a refractory proctitis and further escalation to IV CS, oral or rectal Cyclosporine and Tacrolimus, and biologics may be attempted [3]. Uncontrolled trials have also demonstrated the potential benefit of topical therapy with short-chain fatty acids, Lidocaine, arsenic, Alicaforsen, and appendectomy. However, in selected cases, surgery became an option because of the very poor quality of life [3]. In general, no new robust data is available on the therapy of proctitis, because of its variable disease progression, patients are always excluded in the more recent-randomized controlled trials (RCTs).