Zusammenfassung
Die Proktitis ist in der Klinik ein häufig unterbewertetes Krankheitsbild. Nicht selten führt die Diagnose einer unspezifischen, idiopathischen Proktitis zu einer inadäquaten Therapie. Differenzierte Diagnostik zeigt jedoch die vielfältigen Ursachen wie infektiöse, mitunter sexuell übertragene Erkrankungen, chronisch-entzündliche Darmerkrankungen oder die nicht weithin bekannte allergische Proktitis. Die von den Patienten berichteten Beschwerden sind häufig unspezifisch und umfassen krampfartige Unterbauchschmerzen, Tenesmen, Durchfall oder eine blutig-eitrige Sekretion. Endoskopisch zeigt sich meist ein unspezifisches Bild mit Mukosaödem, Schleimhautrötung, Ulzerationen und (Kontakt-)Blutung. Wichtig sind die histologische Klärung mittels Biopsie, mikrobiologische Untersuchungen und serologische Tests. Nicht selten erfordert die Therapie dieser vielschichtigen Erkrankungen eine interdisziplinäre Betreuung durch den Gastroenterologen und den Chirurgen.
Die ischämische Proktitis, die mechanisch-irritative Proktitis, die medikamentöse Proktitis und die Strahlenproktitis werden im Beitrag von Dr. Jongen in diesem Heft besprochen.
Abstract
Proctitis is commonly an underappreciated disease. Often the diagnosis of “idiopathic proctitis” leads to inadequate therapy. Differential diagnosis and work-up reveal the complex causes of proctitis including infections, often sexually transmitted, or idiopathic inflammatory bowel diseases. Symptoms of proctitis are often unspecific with crampy lower abdominal pain, painful bowel movements (tenesmus), diarrhea, or blood in stool. Endoscopy reveals mucosal edema, erythema, ulcerative lesions, and contact bleeding. Important are the associated histology, microbiology, and serology. Proctitis is a typical interdisciplinary disease that requires expert knowledge on the part of a gastroenterologist and surgeon.
Ischemic proctitis, proctitis caused by mechanical irritants, and drug- and radiation-induced proctitis are discussed in the companion review by Dr. Jongen in this issue.
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Escher, M., Herrlinger, K. & Stange, E. Proktitis – aus gastroenterologischer Sicht. coloproctology 32, 267–272 (2010). https://doi.org/10.1007/s00053-010-0130-7
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DOI: https://doi.org/10.1007/s00053-010-0130-7
Schlüsselwörter
- Proktitis
- Chronisch-entzündliche Darmerkrankung
- Proktitis, allergische
- Tacrolimus
- Diarrhö, antibiotikaassoziierte