American Board of Internal Medicine (ABIM) Certification Practice Exam

Which therapy is recommended for patients with proctitis or left-sided colitis?

1. Systemic glucocorticoids

2. Oral thiopurines

3. Topical 5-aminosalicylate or hydrocortisone suppositories

4. Anti-TNF agents

The correct answer is: Topical 5-aminosalicylate or hydrocortisone suppositories

Topical 5-aminosalicylate or hydrocortisone suppositories are recommended for patients with proctitis or left-sided colitis because these medications deliver anti-inflammatory agents directly to the affected area of the colon. This targeted delivery is particularly effective for localized inflammation, as seen in these types of colitis. 5-aminosalicylates (such as mesalamine) are known for their ability to reduce inflammation in the gastrointestinal tract and are specifically effective in ulcerative colitis, particularly when the inflammation is confined to the distal colon or rectum. When administered topically, they provide concentrated action at the site of inflammation, leading to fewer systemic side effects compared to systemic therapies. Hydrocortisone suppositories function similarly by delivering corticosteroids directly to the rectal area, reducing inflammation and associated symptoms. This approach is beneficial in maintaining mucosal integrity and promoting healing in patients with limited disease involvement. In contrast, systemic glucocorticoids, oral thiopurines, and anti-TNF agents are often reserved for more extensive disease involvement or cases where localized therapies have not been effective. These medications can have broader systemic effects and may not be as appropriate for treating mild or localized cases like proctitis or left