I have been recently diagnosed with ulcerative proctitis and have been treating it with a generic version of Rowasa. The first time that I took the suppositories I had great results. I now have used this treatment a second time with no relief. Does this mean that the disease has gone further up into my colon where the suppository cannot reach?

Monique

Ulcerative proctitis is a variant of ulcerative colitis that primarily involves the rectum. In ulcerative colitis, the entire colon is often involved with an inflammatory process that results in ulcerations, bleeding and destruction of the colon's lining. Patients often experience bloody diarrhea, sometimes associated with abdominal cramps, weight loss and fevers. The diagnosis is made when a colonoscopy is done to evaluate these symptoms.

The cause of ulcerative colitis is unknown, and many medications are available to treat the inflammation. Most of these work by suppressing some element of the inflammatory cascade in the colon.

Patients with ulcerative proctitis tend to not be as ill as those with colitis, who have a greater amount of colon involved. In general, they suffer less severe bleeding, less diarrhea, less weight loss and fewer episodes of fever. One typical symptom of proctitis is tenesmus -- an urgent need to defecate accompanied by pain.

The medications used to treat proctitis are the same as those used in colitis. However, in proctitis patients, these drugs are often given as enemas or suppositories because they work better than oral formulas for problems affecting the last one to two feet of the digestive tract.

Your experience with proctitis is not unusual. Often, symptoms respond well to suppositories initially. However, a large percentage of cases of proctitis will recur after patients stopping taking the medications. Such people may have to take long-term doses of the enemas or suppositories (at less frequent intervals) to prevent relapses.

The fact that your proctitis did not respond the second time indicates one of several possibilities. One is that the disease has become more diffuse in the colon. Proctitis can spread to involve other areas of the colon, and in almost all cases of ulcerative colitis the rectum is involved. This possibility can be evaluated by a colonoscopy to assess the length of colon involved. Another possibility is that you have another problem, such as infection, in addition to the proctitis. Again, colonoscopy with biopsy may aid in this diagnosis, as would collecting the stool for cultures. A third possibility is that the diagnosis of ulcerative proctitis was incorrect. Other causes of rectal inflammation, including infections, can mimic ulcerative proctitis.

Regardless of which of these possibilities is most likely, you should talk with your gastroenterologist to find the reason for your lack of response to the medication and then determine the best course of action to take.