P332 Influence of mesalamine maintenance therapy on progression of ulcerative proctitis in Korea
Y. S. Choi1, W. J. Kim*2, H.-J. Jung3, J. K. Kim1, K.-H. Song3
1Daehang Hospital, Gastroenterology, Seoul, South Korea, 2Soonchunhyang University Hospital, Gastroenterology, Gumi-si, South Korea, 3Daehang Hospital, Surgery, Seoul, South Korea
Ulcerative proctitis (UP) has better prognosis compared with left-sided colitis or extensive colitis, and local mesalamine therapy is a mainstay of inducing and maintaining remission of UP. However, in some UP patients with an acute exacerbation, proximal progression of disease extent is noted. The extensive disease is associated with more advanced treatment or unfavourable clinical course. Nevertheless, clinical features of the extent progression and the influence of mesalamine maintenance therapy have been rarely studied. The aim of this clinical study is to evaluate the potential efficacy of mesalamine maintenance on the extension of the UP.
We reviewed the data of 490 patients (296 males and 194 females; median age 39 years) with an initial diagnosis of UP at Daehang Hospital, Seoul and Soonchunhyang University Hospital, Gumi-si, Korea, from January 2005 to October 2015. UC was categorised as proctitis (E1, limited to the rectum), left-sided colitis (E2, within splenic flexure), and extensive colitis (E3, beyond splenic flexure). Extent progression was defined when the disease extent was stepped-up from E1 to E2 or E3. Patient demographics, disease duration, endoscopic finding, medication history for remission induction and maintenance, clinical relapse, and biological parameters were analysed.
During the follow-up period (median 55 months, range 12–130 months), acute exacerbation (arbitrarily defined as a condition requiring systemic corticosteroid therapy) was found in 90 patients (18.4%). Cumulative incidence rate free of acute exacerbation at 3, 5, and 10 years was 88.9%, 84.2%, and 74.5%, respectively. Of the 90 severely-relapsed patients, 55 (61.1%) revealed the extent progression at colonoscopy. Further 33 patients (36.7%) had not used maintenance therapy in the last 3 months before the actual exacerbation. The progression of the disease extent was found in 49.1% and 81.8% of patients with and without any mesalamine maintenance therapy, respectively (p < 0.01). According to sub-analysis on with or without oral mesalamine, the progression of disease extent found less frequently in the group maintaining oral mesalamine (44.4% vs 77.8%, p = 0.01). However, there was no significant difference according to the maintenance with or without local mesalamine (52.2% vs 70.5%, p = 0.08).
Mesalamine maintenance therapy was associated with a lower risk of the progression of the disease extent in the relapsed patients with UP. Further randomised prospective studies are needed to confirm these results.