and cramping pains in the abdomen, which can be very severe a a stool. The diarrhoea may begin slowly or quite suddenly. Havin harder to hold on to the liquid stools and, with the need to get to may occasionally experience incontinence (accidents). Some peo particularly smelly. Ulcerative Pro People with active UC often feel extremely tired and lethargic. Th Definition itself, as well as a number of other things such as a lack of sleep is a chronic, relapsing up at night with diarrhoea. You may alsoUlcerative have colitis a fever and feel ge Proposed guidelines for management in primary inflammation care limited to the colon. The appetite, so you may lose weight. If you lose a lot of blood you m of inflammation, observed endoscopic Newcastle upon Tyne NHS Foundation Trust, Department of Gastroenterology reduced number of red blood cells), which can also make you fe (need for surgery, colorectal cancer et Ulcerative Proctitis Ulcerative proctitis is disease limited to re the Definition types of UC? The symptoms of UC can vary depending the extent and severity characterised by diffuseon mucosal inflammation limited to the colon.ofThe disease is classified according to the maximal extent the inflammation. Because of this, it of inflammation, correlates with the risk of of complications. helps towhich know which part your colon is affected. The diagram Ulcerative proctitis is disease limited to the rectum. shows the types of UC, from the most limited, proctosigmoiditis proctitis Presentation proctitis, involving just the rectum, to Patients with proctitis tend to have milder symptoms than those with more extensive disease. theusually most extensive, pancolitis, involving Patients present with anorectal bleeding, possibly with the passage of mucous in addition. complain urgency. Stool consistency thePatients entireoften colon. Inofgeneral, if you havecan vary from being normal Ulcerative colitis is a chronic, relapsing remitting disease to diarrhoea or even constipation. Proximal constipation, due to rectal dysfunction, is a Presentation common problem. Patients with proctitis tend to have mil Patients usually present with anorecta Management addition. Patients often complain of u Patients should be managed initially by secondary care. Patients will be referred back to to diarrhoea or even constipation. Pro primary care with a clear diagnosis and management plan. Most patients will only require common problem. treatment during a disease flare as follows: • Always consider acute infection as a potential cause of symptoms in a patient presenting with a disease flare. If necessary, send a stool sample for culture whilst treating the flare, but arrange early review with the results. Newcastle upon Tyne NHS Foundation Trust, Department of Gas • Mesalazine 1g suppository daily is the preferred initial treatment for mild or moderately active proctitis. Suppositories are preferred to enemas as they target the rectum more August 2012 - review date September 2015 efficaciously (although enemas are effective and can be used as an alternative based on patient choice). • Topical steroids (such as colifoam, predfoam, predsol suppositories etc.) should be reserved for second line management, either for patients intolerant of topical mesalazine or as an adjunct in patients with uncontrolled symptoms. • Patients who fail to improve on topical mesalazine and topical steroids should be treated with oral mesalazine 2.4g daily or balsalazide 6.75g daily in addition. Oral 5-ASA alone is less effective. • Proximal constipation should be managed with a stool softener such as sodium docusate or a macrogol laxative for more resistant cases. When to Refer Back to Secondary Care Consider referring back to specialist services (Department of Gastroenterology; RVI fax: 0191 2820523, FRH fax: 0191 2231249) for the following: • Patients with severe proctitis who require ongoing treatment with both a topical agent and a systemic 5-ASA. These patients are likely to need monitoring in secondary care. • Patients who develop evidence of perianal disease. • Patients who develop symptoms of more extensive UC, such as abdominal pain, weight loss, profuse diarrhoea or systemic malaise. • Patients in whom the G.P. is concerned about colorectal cancer can be referred under the normal Two Week Wait pathway. References 1. ECCO Consensus Guidelines, European evidence-based Consenus on the management of ulcerative colitis: Current management, Journal of Crohn’s and Colitis 2008; 2:24-62 2. NACC - Crohn’s and Colitis UK, Ulcerative Colitis Patient Information Booklet 3. IBD Section of BSG, Guidelines for the management of inflammatory bowel disease in adults, Gut 2011; 60:571-607 August 2012 - review date September 2015