Solitary rectal ulcer syndrome: A single-center case series

Clinical and laboratory characteristics of solitary rectal ulcer syndrome: a retrospective analysis of 36 case

The primary objective of this study was to evaluate the clinical, laboratory, and histological characteristics of solitary rectal ulcer syndrome (SRUS) and assess the outcomes associated with various management strategies. This retrospective observational study was conducted at Giresun Education and Research Hospital. This study included patients diagnosed with SRUS between January 2020 and January 2024. Demographic information, clinical presentation, primary diagnosis, and laboratory parameters were obtained from electronic medical records. Statistical analysis was performed using SPSS software, and the chi-square test was used to compare categorical variables. A total of 36 patients diagnosed with SRUS were included, with the majority being male (80.6%), and the mean age of participants was 75.6 years. Hematochezia was identified as the most common initial symptom (61.1%), followed by abdominal pain (16.7%) and constipation (11.1%). Laboratory findings revealed significant abnormalities, including mean hemoglobin levels of 10.0 ± 2.4 g/dL and mean CRP levels of 56.7 ± 65.4 mg/L. Histopathological analysis showed that 38.9% of patients had normal biopsy results, whereas inflammation and dysplasia were observed in 41.7% and 2.8% of cases, respectively. Additionally, a statistically significant difference in age was observed between the patients presenting with different initial symptoms (p = 0.028). The study also found that biopsy results varied significantly across symptom groups (p = 0.012), and although differences in hemoglobin and hematocrit levels across biopsy groups were noted, they were not statistically significant. This study offers a comprehensive analysis of SRUS, emphasizing the importance of detailed clinical and laboratory evaluation. Hematochezia emerged as the most prevalent symptom, and ulcerative colitis was identified as the primary diagnosis. Significant associations were observed between various clinical parameters and patient outcomes, highlighting the necessity of a multidisciplinary approach in managing SRUS.

Solitary Rectal Ulcer Syndrome in Patients Presenting With Lower Gastrointestinal Bleeding: A Tertiary-Care Hospital Experience

BACKGROUND

Solitary rectal ulcer syndrome (SRUS) is a benign rectal condition associated with defecation disorder that has multifactor pathologies and variable findings on presentation, endoscopy, and histopathology. A diagnostic dilemma with an overlap of differentials and step-wise management that starts with conservative therapies and goes up to repeated surgeries in case of failure of the conservative approach.

OBJECTIVE

This study aims to observe clinical, endoscopic, and histological features of SRUS in patients presenting with lower gastrointestinal bleeding.

MATERIAL AND METHODS

The study was conducted at the Department of Gastroenterology, Medical Teaching Institute, Lady Reading Hospital Peshawar from October 2018 to April 2020. After written informed consent, 257 patients (149 males and 108 females) from ages 15 to 70 who presented with lower GI bleeding were included via non-probability convenient sampling. Sociodemographic details were recorded in a pre-designed proforma. A colonoscopy was performed with the Colonoscope CF200 Z, Olympus Tokyo, Japan, and findings were noted. Suspected lesions were magnified, dyed with 0.2% indigo carmine, biopsied from the middle and edges of the ulcer, and sent for histopathology. All data were recorded and analyzed in SPSS-20. The mean with SD was calculated for quantitative variables, and frequency and percentages were calculated for qualitative variables. The chi-square test was used to check the significance, and a p-value of <0.05 was considered statistically significant.

RESULTS

SRUS was found in 17 (6.6%) patients with lower GI bleeding, with a male predominance of 57% (n=11). Perirectal bleeding, constipation, mucous discharge, abdominal pain, and anemia were common clinical findings. Solitary lesions, ulceration, and anterior rectum location were the most common endoscopy findings. Obliterated lamina propria with collagen, ulceration, crypt distortion, and inflammatory infiltrates were common histopathological findings.

CONCLUSION

SRUS is a benign defecation disorder commonly presenting with lower GI bleeding, constipation, straining, and abdominal pain. It needs a stepwise approach with conservative management, medical management, biofeedback, and surgeries as a last resort.

Solitary rectal ulcer syndrome: addition of rectal therapies to biofeedback is more effective than biofeedback alone

AIM

We designed this study to evaluate the effectiveness of the combination of topical rectal therapy with biofeedback in treatment of solitary rectal ulcer compared to single biofeedback therapy.

BACKGROUND

Biofeedback therapy is an appropriate treatment for patients with solitary rectal ulcer syndrome (SRUS) but it seems that it is not effective alone. Topical medical therapies are supposed to have an additive role to biofeedback.

METHODS

This randomized, controlled trial was conducted on 63 patients with SRUS. Patients were randomly enrolled into two groups of combination and single therapy. The patients in combination group (n=31) received biofeedback plus a topical therapy (an enema contained dexamethasone, sulfasalazine and bismuth) and the patients in single therapy group (n=32) were treated with biofeedback alone.

RESULTS

Endoscopic responses to treatment in the combination and single groups were 80% and 50%, respectively (P<0.05). Clinical improvement in symptoms such as difficulty to evacuate, digitation to evacuate, feeling of incomplete evacuation, time to need to evacuation and life style alternation were significantly better in treated group by combination therapy than single therapy. Regarding to the mean total score based on all subjective parameters, the results were also significantly better in the treated group by combination therapy.

CONCLUSION

Topical anti-inflammatory therapies in combination with biofeedback is an efficient treatment for patients with SRUS.