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P294. Distal colitis: Evolution and prognosis during 10 years

F.Z. Ajana1, A. Bousseaden1, W. Essamri1, I. Benlbaghdadi1, A. Essaid1

1CHU Ibn Sina, hepatogastroenterology medical clinic “C”, Rabat, Morocco

Background: The term ‘distal colitis’ applies to the form of ulcerative colitis involving the colon up to the mid portion of the descending colon. Most experts agree that disease extension should be determined according to endoscopic criteria. Whatever definition is given, it is important to note that the upper limit of inflammatory involvement can be reached by topical therapy. This study reviews the main therapeutic strategies, the evolution and the prognosis of this disease.

Methods: A retrospective study of 300 cases with ulcerative colitis between 1983 and January 2009, including 170 cases with distal colitis. Topical and/or oral aminosalicylate therapy was initially instaured in all cases. Alternative treatments were instaured in patients refractory or intolerant to standard treatment.

Results: 87 women and 83 men, aged between 16–72 years old, followed during 10 years 23 patients lost during follow-up. The diagnosis of distal colitis was retained in all cases, with 80 cases of rectosigmoiditis, 60 cases of rectal location and 30 cases of left-sided colitis. 70% of patients were treated by sulfasalazine. The rapid therapeutic effect of topical and/or oral aminosalicylate treatment was obtained in 75% cases, with maintenance of remission during the follow up in 92% cases. However 6 patients presented salicylate sensitivity. Distal colitis refractory to salicylates represented 21% cases and was treated by oral glucocorticoids. 10 patients developed a steroids resistance, 15 cases developed steroids dependance and 1 case developed surrenal failure. 22 cases were treated by Azathioprine. Anti-TNF was instaured in 2 cases with a good response in 1 case and failure in another case requiring a surgical treatment. In 2 cases hepatic cytotoxicity due to azathioprine was noted. A proximal extension of the lesions was noted in 30% cases, the mean follow-up was 10 years years, including 35 cases of rectal location extended to a left colitis and 7 cases of pancolitis. A coloproctectomy with ileo-anal anastomosis was realized in 5 cases with an acute colitis after failure of the medical treatment. No case of carcinoma was noted in our study.

Conclusions: Distal colitis is generally a benign entity. However there are refractory forms to pharmacotherapy with persistence of symptoms affecting patient's quality of life. Extension of the distal colitis up to the splenic flexure was described; the risk of carcinoma was rare. This entity requires a correct therapeutic approach and an appropriate follow-up.