UP is a mild form of UC. Thus, symptoms are typically less severe. Patients frequently report tenesmus, hematochezia, and possibly excretion of mucus. Stool consistency varies widely. Some patients suffer from diarrhea, others from constipation due to functional impairment of the rectum. Anorectal hemorrhages may occur independent of defecation. Lower abdominal pain may be experienced.

• Pain

  They didn’t think it could spread through the colon in just a matter of months so I thought maybe the pain in the upper abdomen was just diarrhea pains.The pain and blood finally subsided in November 2011 for a good 7 months. [ihaveuc.com]

  Pain in the lower abdomen may be experienced. [symptoma.com]

  Some of the side affects attributed to mesalamine have been reported as: Rectal pain Dizziness Nausea Worsening of colitis Headaches Muscle aches Rash Abdominal pain Intracranial hypertension Fever Here's an example medication daily regimen for someone [candidacounsel.com]

  Stop using CANASA and tell your doctor right away if you get any of these symptoms: cramps, stomach (abdominal) pain, bloody diarrhea, chest pain, decrease in the amount of urine, fever, headache, rash, shortness of breath, or fatigue. [canasa.com]

• Weight Loss

  Other symptoms may include Anemia Severe tiredness Weight loss Loss of appetite Bleeding from the rectum Sores on the skin Joint pain Growth failure in children About half of people with UC have mild symptoms. [icdlist.com]

  Or, if you have lost a significant amount of weight, you can qualify under the SSA's disability listing for weight loss, which requires a BMI of 17.5 or less. [disabilitysecrets.com]

  Symptoms include loss of appetite, weight loss, diarrhea, severe pain on the left side of the abdomen, and bleeding. Pan-ulcerative (total) Colitis Affects the entire colon. [ccfa.org]

  In addition to bloody diarrhea and abdominal pain on the left side, a patient may also experience weight loss. [self.com]

  Symptoms include bloody diarrhea, pain in the left side of the abdomen, loss of appetite, and weight loss. Pan-Ulcerative Colitis Affects the entire colon. Symptoms include bloody diarrhea, severe abdominal pain, loss of appetite, and weight loss. [crohnsandcolitis.com]

• Fever

  The most common side effects of CANASA include: dizziness, acne, inflammation of the large intestine (colitis), rectal pain, fever, and rash. Tell your doctor if you have any side effect that bothers you or does not go away. [canasa.com]

  Rarely, it can extend upwards with worsening of symptoms, including fever and diarrhea. It tends to recur. [pezimclinic.com]

  Ulcerative colitis symptoms can include: Abdominal pain/discomfort Blood or pus in stool Fever Weight loss Frequent, recurring diarrhea Fatigue Reduced appetite Tenesmus: A sudden and constant feeling that you have to move your bowels When discussing [crohnsandcolitis.com]

• Severe Pain

  Symptoms include loss of appetite, weight loss, diarrhea, severe pain on the left side of the abdomen, and bleeding. Pan-ulcerative (total) Colitis Affects the entire colon. [ccfa.org]

  Thankfully rare, this life-threatening form of colitis affects the entire colon and causes severe pain, profuse diarrhoea and, sometimes, dehydration and shock. [bowelcancerresearch.org]

  Inflammation and sores in the digestive tract can cause severe pain, malnutrition, intestinal scarring, bleeding, and weight loss. In some cases, removing the damaged area is the only effective treatment. [healthline.com]

  Pancolitis : This usually impacts a person’s entire colon, causing bloody diarrhea that can be severe, abdominal pain, fatigue, and severe weight loss. Acute severe ulcerative colitis : This form of colitis is rare, and it affects the entire colon. [self.com]

  If you have bleeding and mucus in a bowel movement, severe pain, or diarrhea, seek immediate treatment. Complications such as severe bleeding and anemia need immediate medical attention. As a result of severe diarrhea, you also may be dehydrated. [webmd.com]

• Diarrhea

  Diarrhea may be observed but constipation is also possible. Pain in the lower abdomen may be experienced. [symptoma.com]

  Therefore, if patients are lactose intolerant and experience cramps, pain, gas, diarrhea or a bloated feeling in the stomach, they should avoid milk and dairy products. [sandiegocountyclinicaltrials.com]

  Symptoms of proctitis include rectal bleeding, urgency, tenesmus, diarrhea or constipation, and occasionally rectal pain. The causes of proctitis include infection, medication, ischemia, radiation, and ulcerative proctitis. [ncbi.nlm.nih.gov]

  Patients with diarrhea often find that avoiding milk and milk products, spicy foods, and raw fruits and vegetables will improve the diarrhea. If you have questions about how to change your diet, ask your doctor. [colonrectal.org]

  Symptoms Symptoms of ulcerative colitis include diarrhea (often bloody) which may be associated with crampy abdominal pain and sudden urgency to have a bowel movement. The diarrhea may begin slowly or quite suddenly. [gothamgastro.com]

• Abdominal Pain

  This can result in more frequent bowel movements, diarrhea, and abdominal pain. The inflammation associated with ulcerative colitis often affects the lower colon or rectum, but in some cases, it may affect the entire colon. [gothammedicine.com]

  Frequent relapses, abdominal pain and diarrhea have been identified as unfavorable prognostic parameters for extension from UP to UPS and UC. [symptoma.com]

  In addition to bloody diarrhea and abdominal pain on the left side, a patient may also experience weight loss. [self.com]

  Ulcerative Colitis Symptom Severity Mild Up to 4 loose stools per day Stools may be bloody Mild abdominal pain Moderate 4-6 loose stools per day Stools may be bloody Moderate abdominal pain Anemia Severe More than 6 bloody loose stools per day Fever, [crohnsandcolitis.com]

  It may present with profuse watery or bloody diarrhoea and low abdominal pain. It is essential to exclude infection by providing stool specimens at onset of symptoms. [westkentgastro.com]

• Loss of Appetite

  Other symptoms may include Anemia Severe tiredness Weight loss Loss of appetite Bleeding from the rectum Sores on the skin Joint pain Growth failure in children About half of people with UC have mild symptoms. [icdlist.com]

  Symptoms of ulcerative colitis include the below: Diarrhea, which could be bloody Cramping abdominal pain Frequent bowel movements Loss of appetite Weight loss Fatigue Anemia Because ulcerative colitis is a chronic condition, the symptoms may come and [gothammedicine.com]

  Symptoms include bloody diarrhea, pain in the left side of the abdomen, loss of appetite, and weight loss. Pan-Ulcerative Colitis Affects the entire colon. Symptoms include bloody diarrhea, severe abdominal pain, loss of appetite, and weight loss. [crohnsandcolitis.com]

  This leads to many common symptoms of ulcerative colitis including: Diarrhea or loose stool Abdominal pain Bowel urgency Blood in the stool Loss of appetite Weight loss Outside of the intestine, ulcerative colitis can lead to many symptoms in other parts [uclahealth.org]

• Tenesmus

  Symptoms of proctitis include rectal bleeding, urgency, tenesmus, diarrhea or constipation, and occasionally rectal pain. The causes of proctitis include infection, medication, ischemia, radiation, and ulcerative proctitis. [ncbi.nlm.nih.gov]

  The symptoms involved in this Diarrhea, Bleeding, Tenesmus, Mucus discharge, rectal pain, Accidental Bowel Leakage. Medication involve in Treat Ulcerative Colitis are Aminosalicylates, Corticosteroids, Immune modifiers, Antibiotics. [omicsonline.org]

  A common symptom of proctitis is called tenesmus. Tenesmus is a frequent urge to have a bowel movement. Inflammation and irritation of the rectum and rectal lining cause tenesmus. [healthline.com]

  This symptom is called ‘tenesmus’. It is the rectal equivalent to a runny nose when a patient has a head cold. There may or may not be associated lower abdominal cramps and a sense of abdominal bloating. [pezimclinic.com]

• Constipation

  MATERIALS AND METHODS: Eleven patients with quiescent clinical, endoscopic, and histological UP and constipation and 10 patients with functional constipation (FC) underwent radiologic evaluation of intestinal transit time, anorectal manometry, and defecography [ncbi.nlm.nih.gov]

  Acute proctitis has a sudden onset, accompanied by fever, chills, tenesmus (false desires) against constipation, feeling of heaviness in the rectum, a strong burning sensation in it. [medusanews.com]

• Oral Ulcers

  B 22 Patients with ulcerative colitis proctitis should be treated with 5-ASA suppositories rather than oral 5-ASA. [aafp.org]

• Skin Rash

  […] color, facial rash around the mouth, skin rash, skin break-down, secondary infection, thinning of the skin, stretch marks, and heat rash. [medafoams.com]

  For example, you might get mouth ulcers, skin rashes and inflammation (redness or pain) in your eyes, skin or joints. These problems can occur during a flare-up or while you’re in remission. [bupa.co.uk]

  Colitis can be associated with problems such as: Arthritis Inflammation of the eye Liver disease such as hepatitis, cirrhosis and primary sclerosing cholangitis Osteoporosis Skin rashes Anemia Your doctor will ask about your medical history and perform [ucsfhealth.org]

  Ulcerative Colitis can also generate symptoms in other parts of the body, and may include mouth ulcers, skin rashes and lesions and inflammation (redness or pain) in the eyes, skin or joints. [bowelcancerresearch.org]

  Unlike ulcerative proctitis which comes with only utter physical discomfort, Ulcerative Colitis may occur alongside liver disease, skin rash, and joint disorders. [medicalook.com]

• Skin Disease

  Photo Credit Gracia Lam Personal Health A Little-Known Skin Disease That Can Disrupt People’s Sex Lives Patients deal with pain and itching and often encounter medical ignorance and mistreatment until affected tissues become irreparably scarred. [nytimes.com]

  Consumption of turmeric has been found to fight a variety of infections, cancers, skin diseases, and digestive problems. [turmericforhealth.com]

• Pruritus

  Most infusion reactions are mild–moderate and consist of flushing, headaches, dizziness, chest pain, cough, dyspnea, fevers, chills, and pruritus. [gi.org]

• Skin Ulcer

  Other symptoms that may occur with ulcerative colitis include the following: Joint pain and swelling Mouth sores (ulcers) Nausea and vomiting Skin lumps or ulcers Exams and Tests Colonoscopy with biopsy is most often used to diagnose ulcerative colitis [mountsinai.org]

• Seizure

  Azathioprine (Imuran; oral) Not recommended 1.5 to 2.5 mg per kg per day|| $3 Allergic reactions, bone marrow suppression, infection, pancreatitis Cyclosporine (Sandimmune; IV) 2 to 4 mg per kg per day Not recommended $14 Infection, nephrotoxicity, seizures [aafp.org]

  Severe adverse events include nephrotoxicity, infection, and seizures (particularly in patients with associated hypocholesterolemia or hypomagnesemia). [gi.org]

• Incontinence

  Score [CCIS] and the Fecal Incontinence Quality of Life Scale). [ncbi.nlm.nih.gov]

  Symptoms that may manifest include diarrhea, rectal bleeding, painful defecation, incontinence, excess flatulence and intestinal blockage. Intestinal blockage is a result of narrowing of the bowel which blocks the flow of feces. [en.wikipedia.org]

  Ulcerative Colitis Symptoms Common symptoms of ulcerative colitis include the following: Frequent loose bowel movements with or without blood The urgency to have a bowel movement (tenesmus) and bowel incontinence (loss of bowel control) Lower abdominal [emedicinehealth.com]

  Lower abdominal cramping and faecal urgency and/or incontinence (inability to control bowel movement) are also common symptoms. The disease is usually long term with symptomatic periods and asymptomatic periods. [myvmc.com]

  Despite the widespread adoption of these indices in clinical trials, they do not take into account symptoms of abdominal pain, nocturnal bowel movements, urgency, or the dreadful fear of episodes of incontinence, which are often the patients’ greatest [gi.org]

Diagnosis of UP is based on medical history, clinical examination and usually endoscopic evaluation of rectum and sigmoid colon. In UP patients, the latter shows diffuse ulceration of the rectal mucosa. In contrast, ulcers associated with Crohn disease are typically well demarcated. In UP, mucosal hemorrhages may be provoked by minimal contact. Visualization of more proximal parts of the colon should reveal intact intestinal walls, an observation that would not be expected in Crohn disease. Contrary to UC, the latter expands from oral to aboral intestinal regions whereby sites of apparently unaltered mucous membranes may be interspersed between ulcerative lesions. The endoscopic examination should be used to obtain biopsy samples that should undergo subsequent pathohistological analysis.

Additional diagnostic imaging is indicated if the patient's condition can either not be distinguished from Crohn disease or if other causes of proctitis have to be ruled out. While UP and all other forms of UC are restricted to the large intestine, this is not the case in Crohn disease. Most patients suffering from Crohn disease present ileal lesions. Also, the intestinal patterns observable in radiographic images differ between this condition and UC.

Stool cultures may be established to check for infectious agents, e.g., chlamydia, Neisseria gonorrhoeae and Treponema pallidum.

• Thrombocytosis

  Laboratory Parameters/Biomarkers Laboratory parameters that may be associated with active UC include anemia, reactive thrombocytosis, and hypoalbumenia. [cmecorner.com]

  The onset of symptoms can be sudden or gradual. 8 The presence of anemia, thrombocytosis, or hypoalbuminemia may suggest inflammatory bowel disease, but most patients with ulcerative colitis will not have these abnormalities. 9 C-reactive protein level [aafp.org]

• Chlamydia

  The lymphogranuloma venereum (LGV) L2 serotype of Chlamydia trachomatis has been isolated from the rectums of three homosexual men with acute, primary ulcerative proctitis that responded to appropriate anti-chlamydial therapy. [ncbi.nlm.nih.gov]

  If proctitis is related to gonorrhea, syphilis, or chlamydia, appropriate antibiotic treatment is recommended. [medical-dictionary.thefreedictionary.com]

  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. [en.wikipedia.org]

  Proctitis caused by sexually transmitted diseases (STDs) is transmitted through receptive anal intercourse and is most commonly due to gonorrhea and chlamydia, or less commonly lymphogranuloma venereum or herpes virus. [emedicine.medscape.com]

• Colitis

  Corticosteroid and 5-ASA enemas, which reach the splenic flexure of the colon, are recommended for patients with left-sided ulcerative colitis. [ncbi.nlm.nih.gov]

• Colonic Ulcer

  […] only the left side of the colon Pancolitis – involves the entire colon Ulcerative Colitis Symptoms Two of the major ulcerative colitis symptoms are bloody stool and diarrhea. [northshore.org]

  The percentage of the Proctitis to spread into the greater part of your colon is also slim, at the most is 20%. ulcerative proctitis also does not make you vulnerable to colon cancer. [medicalook.com]

  At the time of diagnosis, 30% to 50% of patients have disease confined to the rectum or the sigmoid colon (ulcerative proctitis and proctosigmoiditis), 20% to 30% have left-sided colitis, and approximately 20% have pancolitis. [cmecorner.com]

  Ulcerative colitis is a chronic disease of the large intestine, also known as the colon, in which the lining of the colon becomes inflamed and develops tiny open sores, or ulcers, that produce pus and mucous. [crohnscolitisfoundation.org]

  Erosive proctitis is characterized by erosions on the mucosa of colon, ulcerative proctitis formation of ulcers. Ulcerative proctitis is characterized by multiple erosions or ulcers in the lining of the rectum. [medusanews.com]

Because little is known about etiology and pathogenesis of the disease, treatment is mainly supportive and aims at relieving symptoms and reducing inflammation.

With regards to analgesics, oral acetaminophen is usually the compound of choice.

Contrary to more severe forms of UC, UP is limited to an easily accessible part of the  large intestine. Thus, anti-inflammatory drugs are mostly applied in form of suppositories or enema [9]. These formulations often contain 5-aminosalicylic acid, also known as mesalazine. Alternatively, olsalazine or balsalazide may be administered orally. They release 5-aminosalicylic acid once they reach the large intestine. Although all the aforementioned variants are safe and well tolerated, rectal administration of 5-aminosalicylic acid promises more rapid results. Rectal therapy may be combined with oral therapy if its results are unsatisfying. Patients suffering from diarrhea need to ingest their medication orally. Continuous therapy is required even though symptoms may subside, but frequency of administration and single dose may be reduced if no relapses occur. Research has shown that therapy is most likely to be effective if ulcerative lesions do not extend for more than 20 to 40 cm from the anus [10].

Immunosuppression may also be reached by topical or systemic use of corticosteroids such as prednisolone. They are, however, not indicated for daily long-term therapy. 5-aminosalicylic acid may be combined with corticosteroids.

Patients presenting with diarrhea may benefit from anti-diarrheal therapy. Inhibitors of intestinal motility, parasympatholytics as well as osmotically active and swelling agents may be employed to this end.

Of note, UP patients are generally recommended a balanced, healthy diet. Foods known to irritate the rectum should be avoided if nutritional intake is not affected. Nutrient absorption largely occurs in much more proximal parts of the intestine and nutrient deficiencies are not to be expected from proctitis itself. In patients suffering from moderate hemorrhages, dietary adjustments should be made in order to support hematopoiesis. Severe cases may require dietary supplements.

Contrary to full-blown UC, UP does rarely require surgical intervention. It may become necessary if an exacerbation persists for several days, does not respond to therapy or if the intestinal wall is perforated. These are, however, unlikely scenarios.

Spontaneous remission of UP is likely but it may take many years to occur. Meanwhile, the disease may spread to more proximal parts of the large intestine. While refractory UP, i.e., those cases associated with frequent relapses despite continuous, even systemic drug therapy, abdominal pain and diarrhea negatively affect the likelihood of remission, age seems to be a favorable prognostic parameter for less frequent recurrences and spontaneous remission [3] [7].

Whereas an increased risk for colon cancer has been shown for UC patients, such relation has not been demonstrated for UP or UPS [1].

Causes of UP, UPS and UC are currently unknown.

An autoimmune pathogenesis seems likely and this theory corroborated by the fact that immunosuppressive therapy is most effective in reducing symptoms associated with these forms of inflammatory bowel disease.

Certain patients may be predisposed for such an autoimmune reaction, but genetic disorders triggering UP at some point in a person's life have not yet been identified.

There is general consensus that neither dietary factors nor stress may single-handedly cause UP, but they may certainly exacerbate the disease and provoke relapses.

There is not proof for an infectious pathogenesis and thus, the disease is not considered contagious.

An annual incidence of slightly more than 2 per 100,000 individuals has been reported for UP [5]. However, most available epidemiologic data refer to UC rather than UP. In this context, it may be of help to know that UP accounts for about 25% of all UC cases. The annual incidence of UC has repeatedly been estimated to be 10 per 100,000 persons [5] [6]. Interestingly, incidence rates were considerable lower until the 1970s - a phenomenon that could not yet be explained. Actual prevalence of UC may approximate 100 per 100,000 inhabitants.

With regards to age distribution, two peaks have been observed in UC patients. The first one occurs during the second or third decade of life, the second one in people aged 60 years and older [7]. Similar observations have been made decades ago [8]. Although the disease may be developed at any age, it is rarely seen in children aged less then 10 years.

It has been suggested that there are more men among old UC patients than women, while in general, females are affected more frequently than males.

Caucasians seem to be affected more often than other races. With regards to ethnicities, particularly high incidence rates have been reported in Ashkenazi Jews. However, these hypotheses need further corroboration and may not be universally applicable. In general, the disease is more common in the Western world and occurs less frequently in Asia.

Of note, UC is about three times more common than Crohn disease.

Understanding of UP, UPS and UC pathogenesis is limited due to knowledge gaps regarding the diseases' etiology.

In UC, ulcerative mucosal lesions can be found in distinct parts of the large intestine. In case of UP, they are restricted to the rectum. All UC patients suffer from UP, but the disease' proximal extension differs widely between individual patients. Contrary to Crohn disease, deeper layers of the intestinal wall are not affected. However, mucosal lesions are sufficient to provoke hemorrhages and subsequent hematochezia.

These characteristic lesions result from chronic inflammation of the mucosal layer. Histopathological analyses show infiltration of the mucosa with inflammatory cells. They release pro-inflammatory mediators and thus cause tissue damage. An autoimmune process presumably accounts for these pathophysiological events.

While there are several general recommendations to prevent proctitis, little can be advised regarding UP. A balanced, healthy diet low in caffeine, alcohol and fat may contribute to reduce the frequency of relapses and the overall severity of the disease. If patients note that certain foods irritate their intestines, they should avoid these comestibles. Similarly, other situations that are individually identified as triggers of symptomatic bouts should be evaded. Some patients benefit from stress-reducing techniques. Safer sex should be practiced and anal intercourse should be avoided during periods of exacerbation.

Ulcerative colitis (UC) and Crohn disease are the most common examples for inflammatory bowel disease. Both are chronic, relapsing diseases and patients suffer from periods of exacerbation of intestinal symptoms. UC typically spreads from distal parts of the large intestine towards more proximal sections. In this context, ulcerative proctitis (UP) is a mild form of UC. Here, ulcerative mucosal lesions are restricted to the rectum. If the sigmoid colon and the rectum are affected, an ulcerative proctosigmoiditis (UPS) may be diagnosed.

Etiology and pathogenesis of UP are not fully understood. Initially, the disease had been considered an own entity. Nowadays, the above described hypothesis of UP being a form of UC is more widely accepted though. Indeed, the fact that UP may give rise to UPS and UC argues for this theory [1]. Significant shares of UP cases progress to UC. Precise numbers regarding this development exist, but differ widely. On the one hand, it has been reported that approximately 10% of all UP patients develop UC, most likely within the first two years after diagnosis, with later extension being less likely. Other studies relate rates of up to 30 and 50% within 10 and 25 years, respectively [2] [3]. Frequent relapses, abdominal pain and diarrhea have been identified as unfavorable prognostic parameters for extension from UP to UPS and UC.

Spontaneous remission of UP is possible and has been documented, for instance, in controlled studies for patients who received placebos. Remission rates of up to 39% have been reported in rather short periods of time [4], while retrospective analysis has shown that about 75% of all UP cases remit within 25 years [2]. Nevertheless, treatment is most certainly indicated to relieve symptoms and to augment the probability of remission. Due to persisting knowledge gaps regarding UP etiology treatment is mainly supportive.

Ulcerative proctitis (UP) is a chronic disease associated with mucosal lesions throughout the rectum. Similar to Crohn disease and ulcerative colitis (UC), it is an inflammatory bowel disease and in fact, UP may progress to UC.

Causes

The precise causes of UP and UC are not yet known. They have been repeatedly proposed to result from an autoimmune reaction, i.e., an immune response against endogenous structures. Such an immune response could activate inflammatory cells located in the rectal mucosa. These cells subsequently release pro-inflammatory mediators that, in turn, trigger damage to the mucosal layer. And while there is no doubt about UP and UC being an inflammatory disease, the initial trigger of inflammatory cell activation has not yet been identified.

The disease has a relapsing course. Some patients describe exacerbation to occur in situations of stress and practice stress-reducing techniques to prevent recurrences.

Symptoms

The most common symptoms are the urgent need to pass stool even though only little quantities can be excreted. The ulcerative lesions of the rectal mucosa are vulnerable and tend to bleed. Thus, fresh blood can often be seen in stools. Anorectal bleedings may also occur independent of defecation. Some patients also observe passing of mucus.  Diarrhea may be observed but constipation is also possible. Pain in the lower abdomen may be experienced.

Diagnosis

While medical history and clinical examination may prompt a strong suspicion for UP, it is usually necessary to visualize rectum and distal parts of the colon applying a procedure called sigmoidoscopy. It is a form of endoscopy and involves advancing a small camera through rectum and distal colon. It allows for an evaluation of the intestinal walls and for an assessment of the extent of the disease.

Additional diagnostic imaging and stool cultures may be performed to rule out other causes of proctitis.

Treatment

Treatment aims at relieving pain, reducing mucosal inflammation and decreasing the frequency of relapses. To this end, analgesics such as acetaminophen are usually combined with anti-inflammatory drugs. The latter may be applicated orally, but rectal administration in form of suppositories or enema does often promise quicker results. Of note, this does not apply for more extended forms of UC since effective compounds applied rectally are unable to reach more proximal parts of the colon.

Patients suffering from diarrhea will additionally be treated with anti-diarrheal drugs.

Although spontaneous remission of UP is likely, it may take several years for it to occur. In the meantime, drug therapy should be continued as indicated by the attending physician.

1. Farmer RG. Evolution of the concept of proctosigmoiditis: clinical observation. Med Clin North Am. 1990; 74(1):91-102.
2. Meucci G, Vecchi M, Astegiano M, et al. The natural history of ulcerative proctitis: a multicenter, retrospective study. Gruppo di Studio per le Malattie Infiammatorie Intestinali (GSMII). Am J Gastroenterol. 2000; 95(2):469-473.
3. Langholz E, Munkholm P, Davidsen M, Nielsen OH, Binder V. Changes in extent of ulcerative colitis: a study on the course and prognostic factors. Scand J Gastroenterol. 1996; 31(3):260-266.
4. Campieri M, De Franchis R, Bianchi Porro G, Ranzi T, Brunetti G, Barbara L. Mesalazine (5-aminosalicylic acid) suppositories in the treatment of ulcerative proctitis or distal proctosigmoiditis. A randomized controlled trial. Scand J Gastroenterol. 1990; 25(7):663-668.
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7. Jang ES, Lee DH, Kim J, et al. Age as a clinical predictor of relapse after induction therapy in ulcerative colitis. Hepatogastroenterology. 2009; 56(94-95):1304-1309.
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9. Campieri M, Gionchetti P, Belluzzi A, et al. 5-Aminosalicylic acid as enemas or suppositories in distal ulcerative colitis? J Clin Gastroenterol. 1988; 10(4):406-409.
10. Sutherland LR, Martin F, Greer S, et al. 5-Aminosalicylic acid enema in the treatment of distal ulcerative colitis, proctosigmoiditis, and proctitis. Gastroenterology. 1987; 92(6):1894-1898.