Final statements with levels of agreement
| Final statements | Level of agreement (%) | |
| 1 | In patients who are compliant to both rectal and oral therapy over an 8-week period, mesalazine-refractory proctitis is still an existing clinical problem. | WG: 0.78 M: 0.82 N: 0.9 P: 0.53 |
| 2 | Present patient reported outcomes do not capture the symptom burden appropriately in proctitis. Disability, faecal incontinence, urgency, constipation and health-related quality of life are not captured. | WG: 0.83 M: 0.8 N: 0.9 P: 0.83 |
| 3 | Constipation is a common problem in symptomatic refractory proctitis, and efforts should be made to treat it independently of inflammatory disease. | WG: 0.76 M: 0.8 N: 0.65 P: 0.75 |
| 4 | A multidisciplinary team approach should be highly considered and at the appropriate time, a surgical option should also be considered in refractory inflammatory disease, though the type of surgical intervention is as yet unclear. | WG: 0.79 M: 0.84 N: 0.83 P: 0.6 |
| 5 | Patient age and comorbidities should be factored into the decision-making process for therapies in refractory proctitis. | WG: 0.84 M: 0.91 N: 0.75 P: 0.7 |
| 6 | Drug costs should not play a major role in the decision-making process regarding therapies for refractory proctitis. | WG: 0.79 M: 0.76 N: 0.93 P: 0.73 |
| 7 | In the treatment of refractory inflammatory disease, patients prefer oral or systemic therapies rather than topical therapy. | WG:0.7 M: 0.66 N: 0.8 P: 0.78 |
| 8 | Research investigating the role of thiopurines to treat inflammatory disease in mesalazine-refractory proctitis is limited. | WG: 0.73 M: 0.74 N: 0.9 P: 0.57 |
| 9 | Low-dose topical or oral steroid therapy (5 mg prednisolone tablets or suppositories, or budesonide) may be considered to treat symptoms from inflammatory disease in select situations. | WG: 0.84 M: 0.9 N: 0.83 P: 0.83 |
| 10 | Present evidence does not provide any clarity regarding the use and sequencing of biological agents and small molecules to treat inflammatory disease from refractory proctitis. | WG: 0.77 M: 0.81 N: 0.78 P: 0.63 |
| 11 | Combination treatment with immunomodulators and any biological agents should be considered to treat refractory inflammatory disease in proctitis. | WG: 0.8 M: 0.83 N: 0.95 P: 0.55 |
| 12 | After excluding other differential diagnoses, inflammatory disease may be treated with second-line or third-line biological treatments and small molecules. | WG: 0.83 M: 0.87 N: 1.0 P: 0.6 |
| 13 | The role of off-licence topical therapies such as acetarsol or tacrolimus is unclear in the treatment of active inflammatory disease. More research is needed. | WG: 0.8 M: 0.84 N: 0.83 P: 0.65 |
| 14 | Further research should be focused on refractory proctitis. | WG: 0.92 M: 0.94 N: 1.0 P: 0.75 |
M, medical professionals; N, nurse practitioners; P, patients; WG, whole group.