Gagliardi Mario, Sica Mariano, Oliviero Giovanni, Maurano Attilio, Zulli Claudio
Digestive Endoscopy Unit, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Salerno, Italy.
Digestive Endoscopy Unit, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Gaetano Fucito Location, Mercato San Severino (Salerno), Italy.
J Gastrointestin Liver Dis. 2021 Aug 10. doi: 10.15403/jgld-3680.
A 49-years-old woman with a recent history of tenesmus, constipation, abdominal and rectal pain referred to our Unit. There was no previous history of rectal bleeding or a family history of gastrointestinal diseases. Laboratory tests showed haemoglobin 10.9 g/dl, MCV 72fl, ferritin 18 U/l. Physical examination was normal. The patient underwent a colonoscopy which identified a single ulcer of 2.5 cm of diameter without bleeding signs in the distal rectum, 4 cm from the anal margin. Histopathological examination revealed shallow ulceration with fibrosis in lamina propria. We decided to treat the ulcer with one application of Purastat. Four weeks later, a follow-up colonoscopy revealed a complete mucosal healing with only mild residual mucosal erythema. Solitary Rectal Ulcer Syndrome (SRUS) is an uncommon benign proctologic disease usually affecting young adults with a prevalence of 1:100.000 per year, equally affecting women and men with a slight predominance in young women. SRUS is characterized by chronic rectal pain and bleeding, constipation, incomplete evacuation, tenesmus and mucous discharge impairing the patients' quality of life. In past years several topical agents have been used reporting clinical improvements, also if none of them has been evaluated in prospective controlled trials. Purastat (3D-Matrix Europe SAS, France) is a novel self-assembling peptide developed as a haemostatic agent for endoscopic and surgical procedures. In addition to the known haemostatic effect, it has been hypothesized that the activated Purastat nanostructure favors the cell and tissue proliferative process since the similarity of the activated Purastat 3-D nanostructure with the natural extracellular matrix (ECM-SM) scaffold material would result in an adequate adherence of cells and regenerative tissues, achieving more effective healing of the mucosa. Based on this hypothetical re-epithelizing property of Purastat, we decided to use it in this patient, achieving mucosal healing and symptoms improvement.
一名49岁女性因近期出现里急后重、便秘、腹部及直肠疼痛前来我科就诊。既往无直肠出血史，也无胃肠道疾病家族史。实验室检查显示血红蛋白10.9 g/dl，平均红细胞体积72fl，铁蛋白18 U/l。体格检查正常。患者接受了结肠镜检查，发现距肛缘4 cm的直肠远端有一个直径2.5 cm的单发溃疡，无出血迹象。组织病理学检查显示黏膜固有层浅溃疡伴纤维化。我们决定使用一次Purastat治疗该溃疡。四周后，随访结肠镜检查显示黏膜完全愈合，仅残留轻度黏膜红斑。孤立性直肠溃疡综合征（SRUS）是一种罕见的良性直肠疾病，通常影响年轻人，年患病率为1:100000，男女均可发病，年轻女性略占优势。SRUS的特征为慢性直肠疼痛、出血、便秘、排便不尽、里急后重及黏液排出，影响患者生活质量。过去几年中，曾使用多种局部用药报道有临床改善，尽管均未在前瞻性对照试验中进行评估。Purastat（3D-Matrix Europe SAS，法国）是一种新型自组装肽，开发用作内镜及外科手术的止血剂。除了已知的止血作用外，据推测，活化的Purastat纳米结构有利于细胞和组织的增殖过程，因为活化的Purastat 3-D纳米结构与天然细胞外基质（ECM-SM）支架材料相似，会使细胞和再生组织充分黏附，实现黏膜更有效的愈合。基于Purastat这种假设的再上皮化特性，我们决定在该患者中使用，实现了黏膜愈合及症状改善。
