Endoscopic Application of Human Fibrin Sealant in the Treatment of Solitary Rectal Ulcer Syndrome

Ederle, A.; Bulighin, G.; Orlandi, P. G.; Pilati, S.

doi:10.1055/s-2007-1010574

Cited by 27 publications

(13 citation statements)

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“…Their long term benefit is therefore uncertain. They include the use of human fibrin sealant on the ulcer15 or the excision of the ulcer using NdYAG lasers 16…”

Section: Discussionmentioning

confidence: 99%

Prospective evaluation of the treatment of solitary rectal ulcer syndrome with biofeedback

Vaizey

Roy

Kamm

1997

Gut

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Background-Solitary rectal ulcer syndrome (SRUS) is often resistant to medical and surgical treatment. Aim-To determine whether biofeedback retraining is a useful treatment for this condition. Patients-Thirteen consecutive patients with SRUS (three men, median age 34 years, median duration of symptoms three years) underwent treatment. Previous surgical treatment had failed in five. Methods-Patients were evaluated prospectively. Anorectal physiological studies were performed in 11 patients before treatment. A standardised questionnaire was used before and after treatment, and all but two patients were examined after treatment. Results-Median follow up was nine months (range 3-22 months). After treatment four patients were asymptomatic, and four felt improved. Symptom improvement or elimination occurred in: need to strain (7/13 patients), digitation (7/11), laxative use (5/9). Time in the toilet (median 30 v 10 minutes, before v after treatment) and number of visits to toilet (6 v 3/day) were also improved. Three patients were able to maintain employment before treatment compared with eight after treatment. The solitary ulcer did not heal completely in any of the nine patients examined after treatment, but improved in four. Previous surgery, the macroscopic appearance of the ulcer, the presence of pelvic floor paradox, and other physiological parameters did not predict outcome. Conclusion-Biofeedback retraining is a useful treatment for this condition. Long term studies are now required. (Gut 1997; 41: 817-820)

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“…Their long term benefit is therefore uncertain. They include the use of human fibrin sealant on the ulcer15 or the excision of the ulcer using NdYAG lasers 16…”

Section: Discussionmentioning

confidence: 99%

Prospective evaluation of the treatment of solitary rectal ulcer syndrome with biofeedback

Vaizey

Roy

Kamm

1997

Gut

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“…A significant difference was seen in ulcer healing at 2 weeks in that every patient receiving fibrin had healed but none of those receiving dietary therapy had healed. At 1 year, there was no statistical difference in ulcer healing between the two groups [38].…”

Section: Human Fibrin Sealantmentioning

confidence: 76%

Nonsurgical therapy for solitary rectal ulcer syndrome

Bishop

Nowicki

2002

Curr Treat Options Gastro

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The treatment of solitary rectal ulcer syndrome (SRUS) remains problematic and is less than ideal. Prospective, well-designed studies assessing the efficacy of treatment for SRUS are few; most of the knowledge imparted for treating SRUS is experiential. As such, firm treatment recommendations can not be made. Rather, a conservative, stepwise, individualized approach must be employed. Diagnostic modalities should be incorporated in the management scheme to direct treatment when indicated. Management must include patient reassurance that the underlying lesion is benign, because complete "cures" are uncommon in those with SRUS. The goals of therapy should be discussed with the patient prior to initiating treatment. Although the ultimate goal is macroscopic and microscopic healing, a realistic goal is cessation or minimization of symptoms. We outline a reasonable approach to the management of SRUS. Histologic confirmation of SRUS should prompt a discussion of the presumed pathogenic mechanisms with the patient. Conservative therapy with dietary fiber, bowel retraining, and bulk laxatives should be employed. If symptoms persist, the patient should receive a trial of sucralfate enemas for 6 weeks. Individuals who respond should continue conservative therapy. However, if symptoms persist, defecography can be done to assess for inappropriate puborectalis contraction and occult rectal mucosal prolapse. Patients with inappropriate contraction of the puborectalis can be offered biofeedback. Patients with occult rectal mucosal prolapse can be considered for surgery. However, the risks, benefits, and success rates of surgery should be discussed at length, prior to any procedure being performed. Rectopexy or Delorme's procedure offer the best success rates to date; however, the choice of surgical procedure must take into account the experience of the surgeon and wishes of the patient.

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“…Medical therapeutic options include systemic and topical medications such as corticosteroid and sucralfate enemas [6, 7], human fibrin sealant [8] and sulfasalazine, both orally and topically [9, 10]. …”

Section: Discussionmentioning

confidence: 99%

An Interesting Case of Mistaken Identity

Umar¹,

Heigh²

2008

Case Rep Gastroenterol

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Solitary rectal ulcer syndrome (SRUS) is an uncommon disorder which can present in patients being evaluated for defecatory disorders or which can present as a primary process often involving hematochezia, rectal pain and tenesmus. Unfortunately the diagnosis of this disorder is often delayed due to misdiagnosis and/or physician unfamiliarity with the condition. We present a 24-year-old female who presented with 6 months of bloody diarrhea and weight loss. She had been receiving treatment for a presumed diagnosis of inflammatory bowel disease (IBD) due to an endoscopic picture of rectal thickening, edema and ulceration and had been on prednisone for 2 months prior to presentation without relief of her symptoms. After further testing including repeat endoscopy with biopsies, defecography and anorectal manometry, the diagnosis of SRUS was made and treatment was changed. Medical management was unsuccessful and she ultimately required surgical intervention. This case highlights the difficulty in diagnosing SRUS due to its resemblance to other gastrointestinal diseases and should serve as a reminder that if a patient is not responding to IBD therapy, another etiology should be considered.

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Endoscopic Application of Human Fibrin Sealant in the Treatment of Solitary Rectal Ulcer Syndrome

Cited by 27 publications

References 0 publications

Prospective evaluation of the treatment of solitary rectal ulcer syndrome with biofeedback

Prospective evaluation of the treatment of solitary rectal ulcer syndrome with biofeedback

Nonsurgical therapy for solitary rectal ulcer syndrome

An Interesting Case of Mistaken Identity

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