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Ulcerative proctitis — ESEGH MCQ

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EasyInflammatory Bowel DiseaseUlcerative proctitisESEGH

A 24-year-old woman presents with rectal bleeding and tenesmus. Stool culture and testing for Clostridioides difficile are negative. Flexible sigmoidoscopy shows continuous granular inflammation extending from the anal verge to 12 cm, with normal mucosa proximally. Histology demonstrates chronic active proctitis without granulomas. She is systemically well and her CRP is normal. What is the most appropriate first-line treatment to induce remission?

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Correct answer: C — Rectal mesalazine

The correct answer is **E, rectal mesalazine**. Continuous inflammation confined to the distal 12 cm, rectal bleeding and tenesmus, chronic active histology, and absence of systemic toxicity indicate mild ulcerative proctitis. NICE recommends a topical aminosalicylate as first-line treatment for induction of remission; a mesalazine suppository is particularly suitable for disease confined to the rectum. Intravenous hydrocortisone is reserved for acute severe ulcerative colitis, while infliximab is used for selected moderate-to-severe or refractory disease. Subtotal colectomy is inappropriate without severe, medically refractory disease or a surgical complication. Oral vancomycin treats Clostridioides difficile infection, which has been excluded here.

Reference: National Institute for Health and Care Excellence. Ulcerative colitis: management (NG130), section 1.2, recommendation 1.2.1. 2019. https://www.nice.org.uk/guidance/ng130/chapter/recommendations