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Surgical interventions for inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn's disease, are essential in managing symptoms and addressing complications. The selection of surgical procedures is contingent upon the specific conditions and complications that stem from these illnesses.
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Management of refractory ulcerative proctitis.

Manuel Barreiro-de Acosta1, Francisco Mesonero2, Rocío Ferreiro-Iglesias1

  • 1Departamento de Gastroenterología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España; Instituto de Investigaciones Sanitarias de Santiago (IDIS), Santiago de Compostela, La Coruña, España.

Gastroenterologia Y Hepatologia
|December 22, 2025
PubMed
Summary

Refractory ulcerative proctitis (RUP) affects nearly 30% of patients, significantly impacting quality of life. This study provides practical recommendations for RUP diagnosis and management to address knowledge gaps.

Keywords:
ConsensoConsensusProctitis ulcerosa refractariaRefractory ulcerative proctitisRevisión sistemáticaSystematic review

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Area of Science:

  • Gastroenterology
  • Clinical Medicine
  • Pharmacology

Background:

  • Ulcerative proctitis (UP) typically follows a milder course.
  • However, a subset of patients experiences significant symptom burden, severe disease, or refractory UP (RUP).
  • Understanding RUP is crucial for improving patient outcomes.

Purpose of the Study:

  • To characterize refractory ulcerative proctitis (RUP).
  • To develop evidence-based recommendations for the daily management of RUP.
  • To address existing knowledge gaps in RUP clinical presentation and treatment.

Main Methods:

  • A systematic review of 43 low to moderate quality articles was performed.
  • Epidemiological, clinical, and pharmacological treatment aspects of RUP were analyzed.
  • A nominal focus group of gastroenterologists, a nurse, and a patient discussed findings and proposed management statements.

Main Results:

  • Nearly 30% of patients with UP present with RUP.
  • RUP significantly impacts patients' quality of life.
  • Knowledge gaps were identified regarding RUP characteristics, disease course, and treatment efficacy/safety.
  • Thirteen practical statements on RUP diagnosis, treatment goals, selection, monitoring, and nursing roles were agreed upon.

Conclusions:

  • Refractory ulcerative proctitis (RUP) is a common condition with a substantial impact on patient well-being.
  • Further research is necessary to fully characterize RUP and evaluate long-term treatment efficacy.
  • The developed statements offer practical guidance for managing RUP and filling current knowledge deficits.