1. Sarikaya, Murat MD
  2. Filik, Levent MD
  3. Dogan, Zeynal MD
  4. Ergul, Bilal MD

Article Content

To the Editor,


Proctalgia is among the common untoward effects of telaprevir. Anorectal disorders such as hemorrhoids and proctalgia are seen in 28% of the patients on triple therapy with telaprevir (Cunningham & Foster, 2012). However, there is scanty of data to explain the telaprevir-related proctalgia in the absence of perianal disease such as hemorrhoids in those patients. In this regard, we present a chronic Hepatitis C virus (HCV) patient on triple therapy with telaprevir because of relapse. The 65-year-old woman without any previous dyspeptic or anorectal complaints started to complain proctalgia at the end of first month of triple therapy. Rectosigmoidoscopic examination was normal. Anorectal manometry revealed a significant decrease in rectal compliance. She started to feel first sensation at 10 ml of balloon inflation. Intolerable pressure was 20 ml of inflation (Figure 1). Rectoanal inhibitory reflex and other features were within normal limits. Tribenoside suppository was given and her proctalgia was alleviated in 2 weeks.

Figure 1 - Click to enlarge in new windowFIGURE 1. Anorectal manometry findings of the patient.

Rectal compliance might decrease because of inflammatory or functional bowel diseases (Zar, Benson, & Kumar, 2006). However, the cause of rectal compliance decrease related with telaprevir was not clarified yet. Proctalgia in our patient was explained with rectal compliance decrease with manometry. So more patient data with detailed manometric examinations are necessary to clarify the mechanism and treatment of proctalgia in those patients for a better patient compliance to this important HCV treatment. At last, proctalgia in telaprevir patients should remind the decrease in rectal compliance.


Murat Sarikaya, MD


Levent Filik, MD


Zeynal Dogan, MD


Bilal Ergul, MD


Department of Gastroenterology


Ankara Education and Research Hospital


Ankara, Turkey




Cunningham M., Foster G. R. (2012). Efficacy and safety of telaprevir in patients with genotype 1 hepatitis C infection. Therapeutic Advances in Gastroenterology, 5(2), 139-151. [Context Link]


Zar S., Benson M. J., Kumar D. (2006). Rectal afferent hypersensitivity and compliance in irritable bowel syndrome: Differences between diarrhoea predominant and constipation predominant subgroups. European Journal of Gastroenterology & Hepatology, 18, 151-158. [Context Link]