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P271 Epidemiological characteristics and factors associated with ulcerative proctitis progression

A. Dimitriu*1, S. Necula1, B. Cotruta1, L. Gheorghe1, C. S. Pop2

1Clinical Institute Fundeni, Department of Gastroenterology, Bucharest, Romania, 2Emergency University Hospital Bucharest, Department of Gastroenterology, Sector 5, Bucharest, Romania

Background

Extension of ulcerative proctitis beyond the rectum is associated with worsened prognosis and imposes a change in the therapeutic management and follow-up.

The aim of this study was to evaluate the natural course of ulcerative proctitis, the rate of proximal progression, and the characteristics of patients with change in the disease pattern.

Methods

We retrospectively analysed 61 patients with ulcerative proctitis hospitalised between January 2012 and April 2015. We characterised the group based on the epidemiological, endoscopical, and therapeutic features. We calculated the rate of disease progression and in this sub-group, we evaluated the incidence of the following possible risk factors: age (< 40 y), Mayo score on diagnosis, and type of treatment.

Results

The total group was composed of 47.5% women and 52.2% men. Most of the patients (75.4%) were urban citizens and did not associate smoking as a present/past risk factor (77.6%).The average age at diagnosis was 40.49 years (+/- 13.85). The distribution based on the Mayo score was: 1 (76.24 %), 2 (19.3 %) and 3 (4.46 %). Further, 72.1% of patients received local treatment; 62.3% associated systemic 5-ASA to the local treatment; and 31.1% necessitated corticosteroids. The rate of extension was 31.3%, with 19 patients experiencing disease progression during the 3 years of follow-up (68.4% progressed to E2 and 21.1% to E3).

In the sub-group with disease progression, 52.63% had < 40 years on diagnosis; 57.14% had obtained the Mayo score 2 at diagnosis; and 94.73 % were not-active/ex-smokers. (p = 0.0005). Moreover, 63.15% were receiving treatment with local 5-ASA only, and 32.15% had association with oral 5-ASA.

Conclusion

We found a higher than estimated rate of disease progression (31.3 % in 3 years) compared with the rate reported in the literature (20% in 5 years). We identified the following risk factors for disease progression: young age at diagnosis, Mayo score ≥ 2, and non-active/ex-smoker status (p < 0.005).

In our study, local treatment with 5-ASA without oral 5-ASA association did not prove statistically significant, although the majority of patients with disease progression had this finding (63.15 %).