What’s UP with Ulcerative Proctitis?: It’s Not Always What You Think

Excerpt

A 27-year-old man was referred to the University of North Carolina Multidisciplinary IBD clinic for evaluation of ulcerative proctitis. He was initially evaluated by his gastroenterologist for a three-month history of pain with defecation, hematochezia, constipation, and the sensation of incomplete evacuation. Symptoms progressed to having five bowel movements daily characterized by small-volume stools with mucus as well as frank bleeding. He had lost over ten pounds during this time period. He denied fevers, joint pains, or oral ulcers. He reported one male sexual partner and receptive anal intercourse. Recent testing was negative for HIV, syphilis, and gonorrhea. He denied any known infections among himself or his contacts. He reported cigarette use but denied significant alcohol use or use of recreational drugs. He described regular NSAID use. Colonoscopy revealed moderate-to-severe inflammation in the rectum with ulceration. The remainder of the exam, including evaluation of the terminal ileum, appeared normal. Biopsies of the rectum showed moderate acute and chronic proctitis. Ileal biopsies were negative for inflammation. There was no pathological evidence of infection or dysplasia. He was subsequently started on prednisone for ulcerative colitis limited to the rectum, which worsened his symptoms. He was thus referred to the University of North Carolina Multidisciplinary IBD clinic for further evaluation. …