This protocol applies to patients with mildly to moderately active ulcerative proctitis in whom an initial topical regimen failed to induce remission. The approach described here represents the structured next step following that failure.
The preceding line included topical corticosteroids (suppository, foam, or enema), tacrolimus suppository, or beclomethasone suppository. Escalation to this protocol is indicated when those therapies did not achieve the required remission endpoints: absence of rectal bleeding, resolution of bowel urgency, normalized stool frequency, and a Mayo endoscopic score of 0 or 1.
When ulcerative proctitis has not responded to topical therapy, an oral systemic agent is recommended for induction of remission. The complete regimen — including agent selection, sequencing, and all dosing details — is available in the full structured protocol.
Clinical response is expected within 5–7 days, with the primary indicators being decreasing rectal bleeding and decreasing stool frequency.
In patients with UC of any extent who fail to respond to 5-ASA therapy, we recommend oral systemic corticosteroids to induce remission.
The typical starting doses of oral prednisone are 40–60 mg daily, usually in a single dose, and clinical response is expected within 5–7 days of treatment.
DOI: 10.14309/ajg.0000000000003463
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