proctitis

直腸炎 　

WordNet

1. inflammation of the rectum; marked by bloody stools and a frequent urge to defecate; frequently associated with Crohns disease or ulcerative colitis

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/06/29 08:11:46」(JST)

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Proctitis
Classification and external resources
ICD-10	K51.2, K62.7, K62.8
ICD-9	098.7, 556.2, 569.49
DiseasesDB	25171
MedlinePlus	001139
eMedicine	emerg/487 med/2742
MeSH	D011349

Proctitis is an inflammation of the anus and the lining of the rectum, affecting only the last 6 inches of the rectum.

Overview

Symptoms are ineffectual straining to empty the bowels, diarrhea, rectal bleeding and possible discharge, a feeling of not having adequately emptied the bowels, involuntary spasms and cramping during bowel movements, left-sided abdominal pain, passage of mucus through the rectum, and anorectal pain.

Causes

A colonoscopy showing radiation proctitis.

Proctitis has many possible causes. It may occur idiopathically (idiopathic proctitis). Other causes include damage by irradiation (for example in radiation therapy for cervical cancer and prostate cancer) or as a sexually transmitted infection, as in lymphogranuloma venereum and herpes proctitis. Proctitis is also linked to stress and recent studies suggest a celiac disease-associated "proctitis" can result from an intolerance to gluten.

A common cause is engaging in anal sex with multiple partners infected with sexual transmitted diseases in men who have sex with men. Shared enema usage has been shown to facilitate the spread of Lymphogranuloma venereum proctitis.

Symptoms

A common symptom is a continual urge to have a bowel movement—the rectum could feel full or have constipation. Another is tenderness and mild irritation in the rectum and anal region. A serious symptom is pus and blood in the discharge, accompanied by cramps and pain during the bowel movement. If there is severe bleeding, a condition called anemia can also be caused, showing symptoms such as pale skin, irritability, weakness, dizziness, brittle nails, and shortness of breath.

Sexually transmitted proctitis

Gonorrhea (Gonococcal proctitis)

This is the most common cause. Strongly associated with anal intercourse. Symptoms include soreness, itching, bloody or pus-like discharge, or diarrhea. Other rectal problems that may be present are anal warts, anal tears, fistulas, and hemorrhoids.

Chlamydia (chlamydia proctitis)

Accounts for twenty percent of cases. People may show no symptoms, mild symptoms, or severe symptoms. Mild symptoms include rectal pain with bowel movements, rectal discharge, and cramping. With severe cases, people may have discharge containing blood or pus, severe rectal pain, and diarrhea. Some people suffer from rectal strictures, a narrowing of the rectal passageway. The narrowing of the passageway may cause constipation, straining, and thin stools.

Herpes Simplex Virus 1 and 2 (herpes proctitis)

Symptoms may include multiple vesicles that rupture to form ulcers, tenesmus, rectal pain, discharge, hematochezia. The disease may run its natural course of exacerbations and remissions but is usually more prolonged and severe in patients with immunodeficiency disorders. Presentations may resemble dermatitis or decubitus ulcers in debilitated, bedridden patients. A secondary bacterial infection may be present.

Syphilis (syphilitic proctitis)

The symptoms are similar to other causes of infectious proctitis; rectal pain, discharge, and spasms during bowel movements, but some people may have no symptoms. Syphilis occurs in three stages.

• The primary stage: One painless sore, less than an inch across, with raised borders found at the site of sexual contact, and during acute stages of infection, the lymph nodes in the groin become diseased, firm, and rubbery.
• The secondary stage: A contagious diffuse rash that may appear over the entire body, particularly on the hands and feet.
• The third stage: Occurs late in the course of syphilis and affects mostly the heart and nervous system.

Diagnosis

Doctors can diagnose proctitis by looking inside the rectum with a proctoscope or a sigmoidoscope. A biopsy is taken, in which the doctor scrapes a tiny piece of tissue from the rectum, and this tissue is then examined by microscopy. The physician may also take a stool sample to test for infections or bacteria. If the physician suspects that the patient suffers from Crohn's disease or ulcerative colitis, colonoscopy or barium enema X-rays are used to examine areas of the intestine.

Treatment

Treatment for proctitis varies depending on severity and the cause. For example, the physician may prescribe antibiotics for proctitis caused by bacterial infection. If the proctitis is caused by Crohn's disease or ulcerative colitis, the physician may prescribe the drug 5-aminosalicyclic acid (5ASA) or corticosteroids applied directly to the area in enema or suppository form, or taken orally in pill form. Enema and suppository applications are usually more effective, but some patients may require a combination of oral and rectal applications.

Another treatment available is that of fiber supplements such as Metamucil. Taken daily these may restore regularity and reduce pain associated with proctitis.

References

External links

• eMedicine
• Force9
• WebMD

UpToDate Contents

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• 1. 潰瘍性直腸炎、直腸S状結腸炎、左側（遠位）大腸炎の管理 management of ulcerative proctitis proctosigmoiditis and left sided distal colitis
• 2. 放射線性直腸炎の臨床的特徴、診断、および治療 clinical features diagnosis and treatment of radiation proctitis
• 3. 放射線性直腸炎の発生率および予防 incidence and prevention of radiation proctitis
• 4. クラミジア・トラコマティス感染症の臨床症状および診断 clinical manifestations and diagnosis of chlamydia trachomatis infections
• 5. 結腸直腸癌長期生存患者へのアプローチ approach to the long term survivor of colorectal cancer

English Journal

• Early outcomes from three prospective trials of image-guided proton therapy for prostate cancer.

• Mendenhall NP, Li Z, Hoppe BS, Marcus RB Jr, Mendenhall WM, Nichols RC, Morris CG, Williams CR, Costa J, Henderson R.SourceUniversity of Florida Proton Therapy Institute, Jacksonville, FL.
• International journal of radiation oncology, biology, physics.Int J Radiat Oncol Biol Phys.2012 Jan 1;82(1):213-21. Epub 2010 Nov 17.
• PURPOSE: To report early outcomes with image-guided proton therapy for prostate cancer.METHODS AND MATERIALS: We accrued 211 prostate cancer patients on prospective Institutional Review Board-approved trials of 78 cobalt gray equivalent (CGE) in 39 fractions for low-risk disease, dose escalation fro
• PMID 21093164

• Reactive Arthritis Associated With Proctitis Due to Chlamydia trachomatis Serovar L2b.

• Pendle S, Gowers A.SourceFrom the *Department of Microbiology, Pathology NSW, Bella Vista, Sydney, Australia; and †Holdsworth House Medical Practice, Darlinghurst, Sydney, Australia.
• Sexually transmitted diseases.Sex Transm Dis.2012 Jan;39(1):79-80.
• We report the first case of reactive arthritis associated with lymphogranuloma venereum (LGV) proctitis in Australia. Since 2004, LGV proctitis has emerged as an important infection worldwide in men who have sex with men. While reactive arthritis is usually associated with serovars D to K of Chlamyd
• PMID 22183852

Japanese Journal

• 関節リウマチのメトトレキセートによる治療中に発症した高齢者潰瘍性大腸炎の1例

• 田中 玲子,宮崎 道彦
• 日本大腸肛門病学会雑誌 67(6), 396-401, 2014
• 症例は81歳，男性．平成17年より関節リウマチ（RA）に対してメトトレキセート（MTX）で治療していた．経過中抗ガラクトース欠損抗体（CARF）が著増したため，MTXを一旦中止．その後MTXを再開したが，血便が出現し精査で潰瘍性大腸炎（UC）直腸炎型と診断した．ベタメタゾン坐薬とメサラジン経口治療を開始したが自己中断し，約3ヵ月後症状増悪し入院となった．UCは全大腸炎型に移行していた．しかしメサラ …
• NAID 130004513795

• クラミジア直腸炎の内視鏡像の検討

• 松井 佐織,廣吉 康秀,阿南 会美,阿南 隆洋,菅原 悦子,渡辺 明彦,菅原 淳,藤田 剛,向井 秀一
• 日本消化器内視鏡学会雑誌 56(2), 279-285, 2014
• <I>Chlamydia trachomatis</I>（以下クラミジア）による直腸炎は，イクラ状・半球状小隆起が典型的内視鏡像とされるが，自験例では典型例が少なく，丈の低い隆起や隆起を伴わない例を認めた．自験例28例のうち初回内視鏡検査時に隆起性病変を認めた18例では丈の高い隆起（典型例）を3例（10.7％）に，丈の低い隆起を15例（53.6％）に認めた．隆起を伴わなかっ …
• NAID 130003395960

• 潰瘍性大腸炎に合併した肛門病変　第1報─自験例の検討─

• 小山 文一,藤井 久男,稲次 直樹,吉川 周作,中川 正,中村 信治,植田 剛,錦織 直人,山岡 健太郎,井上 隆,川崎 敬次郎,尾原 伸作,中本 貴透,内本 和晃,中島 祥介
• 日本大腸肛門病学会雑誌 67(2), 59-67, 2014
• クローン病に合併する肛門病変は，合併頻度が高く詳細な報告例も多い．一方，潰瘍性大腸炎に合併する肛門病変については，その頻度も臨床的特徴も明らかにされていない．今回，潰瘍性大腸炎に合併する肛門病変の臨床的特徴を明らかにするために，自験例の検討を行った．合併頻度は2.7％であった．一般の肛門疾患と比較して，痔核・裂肛が少なく（25.5％），痔瘻・膿瘍が多かった（76.2％）．61.9％は全大腸炎型に合 …
• NAID 130003394570

Related Links

• Proctitis | University of Maryland Medical Center

Proctitis Introduction Proctitis is an inflammation of the lining of the rectum, the end of the large intestine where stool passes through. It causes pain, soreness, bleeding, and a discharge of mucus or pus. It can also make you feel ...

• Proctitis | Define Proctitis at Dictionary.com

proctitis acute inflammatory infection of the anus and rectum. The most common cause of proctitis is the direct inoculation of pathogenic microorganisms into the rectum during anal intercourse, but it may be caused by sexually ...

Related Pictures

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★リンクテーブル★

リンク元	「ペラグラ」「直腸炎」

「ペラグラ」

　　[★]

英

pellagra

関

ニコチンアミドアデニンジヌクレオチド NAD

ニコチン酸、ナイアシン、ビタミンB3、ナイアシン欠乏症、ニコチン酸欠乏症

疫学

• 男女比=2:1。これはエストロゲンの代謝産物によってトリプトファンの代謝(つまりナイアシンの生合成？)が阻害される事による。 (HBC.498)　

病因

• ニコチン酸(ニコチン酸からできるニコチンアミドアデニンジヌクレオチド(NAD))の欠乏による

• 1. 食事中のナイアシン不足。

• 飢餓状態にあっては、ナイアシン欠乏のみならず、トリプトファンからナイアシンを合成するための補酵素(鉄、リボフラビン、ビリドキシン)の欠乏によっても生ずる

• 2. トリプトファン吸収障害

• Hartnup diseaseでは細胞膜上のトリプトファン輸送機構が障害されており、小腸からの吸収、腎尿細管での再吸収が障害されるるため(HBC.498)

• 3. 体内での大量消費

• カルチノイド症候群：トリプトファンを原料に大量の5-hydroxytryptamine 5-HT セロトニンを産生(体内のトリプトファン代謝の60%を占めてしまうほど)するためトリプトファンが欠乏し、ナイアシン欠乏を来す(HBC.498)

pellagra 3D

• 皮膚炎 dermatitis
• 下痢 diarrhea
• 痴呆 dementia
• (死 death)

症状

• 皮膚・粘膜症状：皮膚炎(色素沈着/脱出を残す)、舌炎、口角炎、口内炎
• 神経症状：知覚障害、運動失調
• 消化器症状：
• 精神症状：健忘症、認知症

HIM.443

• 初期症状：食欲減退、全身倦怠感、易刺激性(irritability)、腹痛、嘔吐
• 日光照射部位の皮疹(pigmented and scaling)(Casal's necklace, 進行例で見られる)　→　bright red glossitis
• 食道炎、腟炎
• 下痢(直腸炎 proctitisや消化不良に起因する)、うつ、てんかん発作、認知症

疫学

HIM.443

• トウモロコシを主食とした人々に多い：中国、アフリカ、インド。
• 北米では、アルコール中毒、先天的に小腸と腎臓でニコチン酸の吸収が低下しているヒト(Hartnup disease)、カルチノイド症候群(トリプトファンがセロトニンに変換されて消費される)

「直腸炎」

　　[★]

英

proctitis

ラ

rectitis