Drug development for ulcerative proctitis: current concepts

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) characterised by intestinal inflammation limited to the rectum and colonic mucosa.1 At presentation, approximately 30% of patients have inflammation involving the rectum only, termed ulcerative proctitis (UP).2 3 Proximal extension of UP may occur in up to 28% of patients after 5 years follow-up with progression to extensive colitis in 49% of cases.4–8 A population-based study of paediatric-onset UC demonstrated that 25% of patients with paediatric UC had UP at diagnosis and 49% of them presented a colonic extension at maximal follow-up.9 UP is specifically defined by the disease not extending not beyond the rectum (ie, proximal extent of inflammation is distal to the rectosigmoid junction).10 However, there is no universal standard for defining UP. The Montreal classification divides the distribution of UC only into UP (E1: limited to the rectum), left-sided colitis (E2: up to the splenic flexure) and extensive colitis (E3: beyond splenic flexure).11 12 American Gastroenterological Association (AGA) Institute Guidelines defined proctitis as an in inflammation limited to the rectum or <15–20 cm from anus.13 Clinical symptoms vary based of disease extent.14 UP is responsible for distressing symptoms including increased rectal bleeding, tenesmus, urgency, faecal leakage, faecal incontinence and reduced quality of life.4 6 The presence of diarrhoea is variable, and in fact up to 20–30% of patients are have delayed transit and are constipated.14 15 The presence of constipation in patients with UC is associated with women, active disease and distal colon involvement.15 Such data are lacking in patients with UP. Medical management of these patients may be challenging, in part because only limited data are available on the treatment of UP.5 16 The therapeutic approach in patients with UC and specifically UP mainly …