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World J Gastroenterol. Jan 21, 2014; 20(3): 738-744
Published online Jan 21, 2014. doi: 10.3748/wjg.v20.i3.738
Solitary rectal ulcer syndrome: Clinical features, pathophysiology, diagnosis and treatment strategies
Qing-Chao Zhu, Rong-Rong Shen, Huan-Long Qin, Yu Wang
Qing-Chao Zhu, Yu Wang, Department of Surgery, The Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200233, China
Rong-Rong Shen, Huan-Long Qin, Department of Surgery, The Tenth People’s Hospital Affiliated to Shanghai Tongji University, Shanghai 200072, China
Author contributions: Zhu QC and Shen RR contributed equally to this work; Zhu QC and Shen RR wrote the manuscript; Qin HL collected and interpreted the data; Wang Y designed the review and revised the manuscript; all authors have read and approved the final manuscript.
Correspondence to: Yu Wang, Professor, Department of Surgery, The Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, 600 Yishan Road, Shanghai 200233, China.
Telephone: +86-21-64361349 Fax: +86-21-64368920
Received: September 26, 2013
Revised: November 10, 2013
Accepted: December 12, 2013
Published online: January 21, 2014

Solitary rectal ulcer syndrome (SRUS) is an uncommon benign disease, characterized by a combination of symptoms, clinical findings and histological abnormalities. Ulcers are only found in 40% of the patients; 20% of the patients have a solitary ulcer, and the rest of the lesions vary in shape and size, from hyperemic mucosa to broad-based polypoid. Men and women are affected equally, with a small predominance in women. SRUS has also been described in children and in the geriatric population. Clinical features include rectal bleeding, copious mucus discharge, prolonged excessive straining, perineal and abdominal pain, feeling of incomplete defecation, constipation, and rarely, rectal prolapse. This disease has well-described histopathological features such as obliteration of the lamina propria by fibrosis and smooth muscle fibers extending from a thickened muscularis mucosa to the lumen. Diffuse collage deposition in the lamina propria and abnormal smooth muscle fiber extensions are sensitive markers for differentiating SRUS from other conditions. However, the etiology remains obscure, and the condition is frequently associated with pelvic floor disorders. SRUS is difficult to treat, and various treatment strategies have been advocated, ranging from conservative management to a variety of surgical procedures. The aim of the present review is to summarize the clinical features, pathophysiology, diagnostic methods and treatment strategies associated with SRUS.

Keywords: Solitary rectal ulcer syndrome, Pathophysiology, Diagnosis, Treatment, Clinical characteristics, Treatment

Core tip: We summarize the clinical features, pathophysiology, and diagnostic methods associated with solitary rectal ulcer syndrome (SRUS). Several therapies such as topical medication, behavior modification supplemented by fiber and biofeedback, and surgery are also discussed. The review might be conducive to understanding the nature of SRUS more systematically.