P297 Ulcerative colitis and proximal extension of the disease: a sub-group with worse prognosis?
P. Sousa*, D. Martins, J. Pinho, R. Araújo, E. Cancela, A. Castanheira, P. Ministro, A. Silva
Centro Hospitalar Tondela-Viseu, Gastroenterology, Viseu, Portugal
During the course of ulcerative colitis (UC) proximal progression of the disease in relation to its extension at diagnosis may occur. However, little is known about the predictive factors and natural history of patients whose disease progressed.
The aim of this study was to investigate the factors associated with proximal extension in patients with ulcerative proctitis and distal colitis at diagnosis and to evaluate the clinical course of this group of patients.
We conducted a unicentric study with retrospective analysis of clinical data of UC patients with complete medical records, including extension at diagnosis. Proximal extension was defined by apparition of endoscopic features of UC in initially normal segments of the colon. Statistical analysis was performed using Microsoft Excel ® 2013 and SPSS 18.0 ®.
We identified 232 patients with UC: 152 of which with proctitis (53%) and distal colitis (47%) at diagnosis. Further, 24 patients had proximal progression during a mean follow-up of 7.8 years. Gender, positive family history of inflammatory bowel disease, adhesion to treatment, smoking status, extraintestinal manifestations, or serological markers were not associated with a higher risk of progression. On the contrary, use of corticosteroids at diagnosis was associated with the risk of proximal extension (p = 0.03).
Most patients needed hospitalisation (67%) and corticosteroids (75%) at the time of detection of the proximal extension, as the majority of them had moderate-to-severe clinical activity. Only 3 patients were in clinical remission, and the diagnosis was made during routine colonoscopy. When compared with a control group including patients with extensive disease at diagnosis, patients experiencing proximal progression had a higher probability of needing corticosteroids during the course of their disease (p < 0.001), medication with an immunomodulatory or anti-tumour necrosis factor (TNF) (p < 0.001) and a tendency to being corticoresistant or dependent (p = 0.056).
A more severe disease at diagnosis as defined by the need of corticosteroids is associated with the risk of proximal extension in patients with ulcerative proctitis and distal colitis. Moreover, this group of patients may have a more severe clinical course, with a greater need of corticosteroids, immunomodulators, and biological therapy.