This evaluation is especially valuable if a patient with apparent ulcerative proctitis is not responding to standard therapy. The primary goal is to improve and, ideally, to eliminate symptoms. Reducing rectal inflammation, which may persist even after symptoms improve, is also desirable. As these three therapies appear to be equally effective, gastroenterologists debate over which to use first. The choice is based on the severity of the symptoms, as well as the extent and severity of the rectal inflammation as seen through the sigmoidoscope.
Most physicians start with a topical therapy, especially if rectal symptoms are severe.
Both 5-ASA enemas and hydrocortisone enemas are effective. If only the last couple of inches of the rectum are involved, a 5-ASA suppository, given twice daily, or hydrocortisone foam may be all that is needed to improve the patient's symptoms and heal the inflammation. These drugs may achieve success similar to topical therapy and are easier to administer. In some cases, the disease will extend higher into the colon. But, if combined maximum oral and topical therapy fails to work, more potent therapy should be considered.