P214 Ulcerative Proctitis: Predictors and outcomes of disease extension in UC
K. Boland*1, O. Kelly1, D. Keegan1, K. Sheahan2, H. Mulcahy1, G. Cullen1, G.A. Doherty1
1St Vincent's University Hospital, Department of Gastroenterology, Dublin 4, Ireland, 2St Vincent's University Hospital, Department of Pathology, Dublin 4, Ireland
Ulcerative proctitis is a variant of ulcerative colitis anatomically limited to the rectum.Extension of disease beyond the rectum in this subset of patients is associated with a poor prognosis and higher rates of chronic disease activity. We analysed outcomes of patients diagnosed with ulcerative proctitis who demonstrate extension of their disease, seeking to identify associated risk factors for extension and prognosis in these patients.
A retrospective study of a prospectively maintained electronic database of 3,200 patients with IBD attending a single centre.Those with disease extension were compared to patients with stable limited proctitis. A retrospective review of all clinical, endoscopic and histological records was performed to determine disease course and define any identifiable predictors of proximal disease extension.
481 patients with an initial diagnosis of ulcerative proctitis were identified. Records of 110 patients with stable limited proctitis, 42 patients with proctitis and disease extension, and 60 patients with pancolitis at diagnosis were analysed. Disease extension occurred in 33.3% at 1 year, in 45.2% at 1-5 years and in 21.4% at 6-20 years. When compared with patients with limited proctitis, factors significantly associated with extension included non-smoking (p = 0.02, Fishers exact test), and a more severe disease course characterised by greater use of immunosuppression (p < 0.001, Fishers exact test), use of systemic corticosteroids at diagnosis (n = 18,43.9% extenders, n = 12, 10.9% limited proctitis, p < 0.001, Fishers exact test) and history of >2 hospital admissions from diagnosis (p = 0.006, Fishers exact test). Features not predictive of disease extension included family history of IBD, age at diagnosis, and extra-intestinal manifestations. Patients with disease extension are more likely to require surgery (n = 19, 45.23%) than patients with extensive disease at index presentation (n = 14, 23.3%),(p <0.03, Fisher exact test), with follow up from 6 months to 18 years. Extension at 1 year may be more likely to lead to colectomy (p = 0.08).
Proximal disease extension in patients with proctitis is more common in non-smokers and is associated with a more refractory disease course with greater requirement for immunosuppressant use as well as a history of oral or parenteral corticosteroids at diagnosis. These patients are more vulnerable to failure of medical therapy and more likely to require colectomy than patients with extensive disease at diagnosis. Hence, proctitis with proximal disease extension is a poor prognostic indicator and greater understanding of the biology of this phenomenon might facilitate disease modifying treatments strategies.