Evaluation of proctitis

Diseases

Summary

Proctitis refers to inflammation in the rectum. It may result in rectal bleeding or discharge, urgency, painful defecation, tenesmus, and crampy lower abdominal pain. The inflammation can develop as a consequence of exposure of the rectal mucosa to infectious organisms, allergens, radiation, ischemia, and toxins, or diversion of fecal flow from the rectum (diversion proctitis). In addition, it can be the primary location of idiopathic inflammatory bowel disease, such as ulcerative colitis or Crohn disease.

Accurate assessment and identification of the underlying cause is essential for appropriate therapy.

Library

Gram stained photomicrograph of rectal smear revealing the presence of Gram-negative Neisseria gonorrhoeae
Gram stained micrograph of rectal smear revealing the presence of Gram-negative Neisseria gonorrhoeae diplococci
Rectal mucosa showing nonspecific active chronic proctitis in a patient with lymphogranuloma venereum (due to Chlamydia trachomatis)

Citations

Key Articles

Workowski KA, Bachmann LH, Chan PA, et al; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2021. MMWR Recomm Rep. 2021;70:1-187.[Abstract][Full Text]
Daniel R, Mark P, Gauri G, et al. British Association of Sexual Health and HIV (BASHH) United Kingdom national guideline for the management of sexually transmitted enteric infections. International Journal of STD & AIDS. Aug 2023;34(9):588-602.[Full Text]
Vries HJC, Nori AV, Larsen HK, et al. European guideline on the management of proctitis, proctocolitis and enteritis caused by sexually transmissible pathogens. J Eur Acad Dermatol Venereol. Jul 2021;35(7):1434-43.[Full Text]
Lichtenstein GR, Loftus EV, Isaacs KL, et al. ACG clinical guideline: management of Crohn's disease in adults. Am J Gastroenterol. 2018 Apr;113(4):481-517.[Abstract][Full Text]
American Society for Gastrointestinal Endoscopy Standards of Practice Committee, Shergill AK, Lightdale JR, et al. The role of endoscopy in inflammatory bowel disease. Gastrointest Endosc. 2015 May;81(5):1101-21.e1-13.[Abstract][Full Text]

Referenced Articles

1. Workowski KA, Bachmann LH, Chan PA, et al; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2021. MMWR Recomm Rep. 2021;70:1-187.[Abstract][Full Text]
2. Li P, Li J, Ayada I, et al. Clinical features, antiviral treatment, and patient outcomes: a systematic review and comparative analysis of the previous and the 2022 mpox outbreaks. J Infect Dis. 2023 Aug 16;228(4):391-401.[Abstract][Full Text]
3. Hatami H, Jamshidi P, Arbabi M, et al. Demographic, epidemiologic, and clinical characteristics of human monkeypox disease pre- and post-2022 outbreaks: a systematic review and meta-analysis. Biomedicines. 2023 Mar 20;11(3):957.[Abstract][Full Text]
4. Williams HR, Vlavianos P, Blake P, et al. The significance of rectal bleeding after pelvic radiotherapy. Aliment Pharmacol Ther. 2005 May 1;21(9):1085-90.[Abstract]
5. Dearnaley DP, Khoo VS, Norman AR, et al. Comparison of radiation side-effects of conformal and conventional radiotherapy in prostate cancer: a randomised trial. Lancet. 1999 Jan 23;353(9149):267-72.[Abstract]
6. Sharif S, Hyser M. Ischemic proctitis: case series and literature review. Am Surg. 2006 Dec;72(12):1241-7.[Abstract]
7. Iida T, Ohkubo Y, Kubo T, et al. A case of a rectal stricture related to ischemic proctitis following rupture of an aortic aneurysm. Endosc Int Open. 2018 Feb;6(2):E186-9.[Abstract][Full Text]
8. Lane TM, Bentley PG. Rectal strictures following abdominal aortic aneurysm surgery. Ann R Coll Surg Engl. 2000 Nov;82(6):421-3.[Abstract][Full Text]
9. Breen EG, Coughlan G, Connolly CE, et al. Coeliac proctitis. Scand J Gastroenterol. 1987 May;22(4):471-7.[Abstract]
10. D'Haens G, Breysem Y, Rutgeerts P, et al. Proctitis and rectal stenosis induced by nonsteroidal antiinflammatory suppositories. J Clin Gastroenterol. 1993 Oct;17(3):207-12.[Abstract]
11. Glotzer DJ, Glick ME, Goldman H. Proctitis and colitis following diversion of the fecal stream. Gastroenterology. 1981 Mar;80(3):438-41.[Abstract]
12. da Fonseca J, Brito MJ, Freitas J, et al. Acute colitis caused by caustic products. Am J Gastroenterol. 1998 Dec;93(12):2601-2.[Abstract]
13. Daniel R, Mark P, Gauri G, et al. British Association of Sexual Health and HIV (BASHH) United Kingdom national guideline for the management of sexually transmitted enteric infections. International Journal of STD & AIDS. Aug 2023;34(9):588-602.[Full Text]
14. Vries HJC, Nori AV, Larsen HK, et al. European guideline on the management of proctitis, proctocolitis and enteritis caused by sexually transmissible pathogens. J Eur Acad Dermatol Venereol. Jul 2021;35(7):1434-43.[Full Text]
15. World Health Organization. Diagnostic testing for the monkeypox virus (‎MPXV)‎: interim guidance. May 2024 [internet publication].[Full Text]
16. Loftus EV Jr, Silverstein MD, Sandborn WJ, et al. Crohn's disease in Olmsted County, Minnesota, 1940-1993: incidence, prevalence, and survival. Gastroenterology. 1998 Jun;114(6):1161-8.[Abstract]
17. Lichtenstein GR, Loftus EV, Isaacs KL, et al. ACG clinical guideline: management of Crohn's disease in adults. Am J Gastroenterol. 2018 Apr;113(4):481-517.[Abstract][Full Text]
18. American Society for Gastrointestinal Endoscopy Standards of Practice Committee, Shergill AK, Lightdale JR, et al. The role of endoscopy in inflammatory bowel disease. Gastrointest Endosc. 2015 May;81(5):1101-21.e1-13.[Abstract][Full Text]
19. Bentley E, Jenkins D, Campbell F, et al. How could pathologists improve the initial diagnosis of colitis? Evidence from an international workshop. J Clin Pathol. 2002 Dec;55(12):955-60.[Abstract][Full Text]
20. Crispino P, Habib FI, Badiali D, et al. Colorectal motor and sensitivity features in patients affected by ulcerative proctitis with constipation: a radiological and manometric controlled study. Inflamm Bowel Dis. 2006 Aug;12(8):712-8.[Abstract]
21. Pierik M, De Hertogh G, Vermeire S, et al. Epithelioid granulomas, pattern recognition receptors, and phenotypes of Crohn's disease. Gut. 2005 Feb;54(2):223-7.[Abstract][Full Text]
22. Klausner JD, Kohn R, Kent C. Etiology of clinical proctitis among men who have sex with men. Clin Infect Dis. 2004 Jan 15;38(2):300-2.[Abstract]
23. Haboubi NY, Schofield PF, Rowland PL. The light and electron microscopic features of early and late phase radiation-induced proctitis. Am J Gastroenterol. 1988 Oct;83(10):1140-4.[Abstract]
24. World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance. Jun 2022 [internet publication].[Full Text]
25. UK Health Security Agency. Mpox: diagnostic testing. Sep 2024 [internet publication].[Full Text]
26. Centers for Disease Control and Prevention. Guidelines for collecting and handling specimens for mpox testing. Sep 2024 [internet publication].[Full Text]
27. McQuiston JH, Luce R, Kazadi DM, et al. U.S. preparedness and response to increasing clade I mpox cases in the Democratic Republic of the Congo - United States, 2024. MMWR Morb Mortal Wkly Rep. 2024 May 16;73(19):435-40.[Abstract][Full Text]
28. Centers for Disease Control and Prevention. Clinical overview of mpox. Sep 2024 [internet publication].[Full Text]