Mesalazine Treatment for Chronic Proctitis

First-Line Treatment Options

The American Gastroenterological Association recommends mesalazine 1 gram suppository once daily as the preferred initial treatment for mild to moderate proctitis in patients with chronic ulcerative proctitis, with a strong recommendation and moderate quality evidence 1, 2
Mesalazine 1 gram suppository once daily is the preferred initial treatment for mild to moderate proctitis, with suppositories being more appropriate than enemas as they better target the site of inflammation and are more acceptable to patients 1, 2

The American Gastroenterological Association (AGA) strongly recommends mesalazine suppositories for patients with mild-moderate ulcerative proctitis who choose rectal therapy over oral therapy, with a strong recommendation and moderate quality evidence 1, 3
Mesalazine suppositories are superior to placebo in inducing remission with a pooled risk ratio of 0.44 (95% CI 0.34-0.56) 4
Topical mesalazine is more effective than topical steroids for inducing remission in patients with chronic proctitis 2

Topical mesalazine 1g daily combined with oral mesalazine 2-4g daily is an effective first-line therapy for mild to moderate disease in patients with chronic proctitis 5, 6
Combination of topical and oral therapy is more effective than either treatment alone for patients with chronic proctitis 5, 6

For patients intolerant of or refractory to mesalazine suppositories, rectal corticosteroid therapy can be considered as an alternative treatment option for chronic proctitis 1, 2
If patients fail to improve on combination of oral mesalazine with either topical mesalazine or topical corticosteroids, oral prednisolone 40mg daily may be required for patients with chronic proctitis 5
Patients with chronic active steroid-dependent disease should be considered for immunosuppressive therapy 7

Failure to treat proximal constipation, which should be addressed with stool bulking agents or laxatives, is a common pitfall to avoid in patients with chronic proctitis 5
Not considering combination therapy (topical plus oral mesalazine) when response to topical therapy alone is suboptimal is another common pitfall to avoid in patients with chronic proctitis 5, 6