GASTROENTEROLOGY ARTICLE OF THE WEEK
March 2, 2006
Sharara AI, Azar C, Amr SS, et al. Solitary Rectal Ulcer Syndrome: Endoscopic Spectrum and Review of the Literature. Gastrointest Endosc 2005;62:755-762.
1. Clinical features of the solitary rectal ulcer syndrome (SRUS) include
a. typically seen in elderly (>70 years) individuals.
b. women outnumber men by 3:1
c. typically presents with passage of mucus and blood per rectum
d. a history of rectal manipulation to induce a bowel movement is usually present
e. Most patients with SRUS have underlying mucosal prolapse of the rectum
True or False
2. Patients with SRUS should undergo anorectal manometry and defecography even if surgical correction is not planned
3. The cornerstone of therapy for SRUS is dietary and behavioral modifications with minimization of the time spent on the commode.
4. Distortion of crypt architecture is a sign of inflammatory bowel disease and not SRUS
5. Collagen infiltration of the lamina propria, and infiltration with smooth muscle leading to fibromuscular obliteration are the histologic landmarks of SRUS
6. ASA-containing enemas are the most effective medication to treat SRUS
7. Biofeedback is effective in a significant proportion of patients with SRUS, particularly those with a nonrelaxing puborectalis muscle
8. Surgery should be considered for patients with full-thickness mucosal rectal prolapse who do not respond to conservative measures