Overview of induction therapy for ulcerative proctitis or distal colitis in adults

The choice of induction therapy for ulcerative proctitis or distal (left-sided) colitis depends on the extent of the disease, patient preference and available preparations. Effective treatment options include:

• oral 5-aminosalicylate plus rectal therapy (5-aminosalicylate and/or corticosteroid) for initial therapy
• oral corticosteroids or other immunomodulatory drugs for unresponsive disease.

Rectal 5-aminosalicylates are more effective than rectal corticosteroids for distal (left-sided) colitis. Oral or rectal therapy alone may be sufficient for isolated proctitis.

Once clinical remission is achieved, maintenance therapy is generally required to maintain remission. Ideally, patients who responded to rectal mesalazine should continue it as maintenance therapy at a reduced frequency. If stopping rectal therapy, taper over several weeks to stop; if symptoms recur after stopping, restart rectal therapy.