P157. Proximal disease extension and related predicting factors in ulcerative proctitis
B. Kim, S.J. Park, S.P. Hong, T.I. Kim, W.H. Kim, J.H. Cheon, Yonsei University College of Medicine, Department of Internal Medicine and Institute of Gastroenterology, Seoul, South Korea
Ulcerative colitis usually begins in the rectal mucosa, extends proximally to involve varying portions of the bowel, and can take multiple clinical courses. However, the risk factors predictive of proximal extension have yet to be determined. The aim of this study was to evaluate both the natural course of disease and the risk factors influencing the proximal disease extension in ulcerative proctitis.
We retrospectively analyzed 98 patients with ulcerative proctitis at the time of diagnosis who were regularly followed and underwent sigmoidoscopy or colonoscopy between January 2000 and December 2007.
The mean duration of follow-up was 109.2±49.5 months. A total of 27 (27.6%) patients experienced proximal progression of disease extent during the follow-up period. Mayo scores were significantly higher in the extension group compared to patients whose ulcerative proctitis did not extend proximally (p < 0.001). Corticosteroid use at initial diagnosis (both topical and systemic) was also more frequent in the extension group (29.6% vs. 9.9%, p = 0.026). In addition, chronic, continuous disease activation within six months of the initial diagnosis was significantly higher in the extension group (p < 0.001), as was disease relapse and the number of hospitalizations over the entire follow-up period (p < 0.001, and p = 0.002).
According to multivariate analysis, disease extension after the initial diagnosis was associated with chronic disease activation, disease relapse, and hospitalization (p = 0.030, p = 0.042, and p = 0.044, respectively).
Increased severity of disease upon diagnosis of ulcerative proctitis was associated with a higher probability of proximal disease extension during the follow-up period.
Moreover, those with disease extension were more likely to experience relapse and to be hospitalized, indicating poor prognosis.