Clinical features and current treatment approach to ulcerative proctitis

Ulcerative colitis (UC) is a chronic inflammatory condition characterized by persistent inflammation of the colonic mucosa. Ulcerative proctitis (UP), a localized subtype limited to the rectum, accounts for approximately 37% of UC cases. Although often considered less severe than more extensive forms of UC, UP poses unique diagnostic and therapeutic challenges due to its distinct clinical course and the limited availability of targeted research. UP significantly impairs patients' quality of life, yet randomized controlled trials (RCTs) frequently exclude this population, leading to a paucity of high-quality data to guide management. Diagnostic criteria for UP require endoscopic and histopathological confirmation of inflammation confined to within 15 cm of the anal verge once other etiologies are excluded. First-line treatment typically includes topical 5-aminosalicylates (5-ASA) and corticosteroids, which have demonstrated efficacy in inducing remission. For refractory cases, advanced therapies, including biologics and small-molecule agents, offer promising options, though robust evidence specific to UP is limited. This review underscores the gaps in contemporary UP research, including variability in study designs, definitions, and outcome measures, which hinder meta-analyses and the development of standardized treatment guidelines. Furthermore, the role of therapeutic drug monitoring and the long-term benefits of mucosal healing remain unclear in UP. Personalized treatment strategies, informed by disease severity, patient preferences, and access to care are essential. Regular surveillance incorporating clinical and endoscopic assessments is critical to optimize disease control and mitigate complications. Future studies are necessary to define treatment targets, evaluate novel therapies, and establish evidence-based guidelines to improve outcomes for patients with UP.