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* = Presenting author

P514 Proximal extension of distal lesions in patients with ulcerative colitis

T. Sato*1, M. Kawai2, K. Kamikozuru1, Y. Kita1, Y. Yokoyama1, T. Takagawa3, T. Miyazaki1, M. Iimuro1, N. Hida1, K. Hori1, S. Nakamura1

1Hyogo College of Medicine, Department of Inflammatory Bowel Disease, Nishinomiya, Japan, 2Hyogo College of Medicine, Department of Inflammatory Bowel Disease, Nishinomiya, Japan, 3Hyogo College of Medicine, Department of Inflammatory Bowel Disease, Nisinomiya, Japan

Background

Patients with proctitis type ulcerative colitis (UC), as well as patients with left-sided colitis, have distal UC-related lesions. Further, over time, the distal lesions may progress proximally. However, the time course and factors associated with the proximal extension (PE) of distal lesions are not known well. This observational study was to better understand the outcome of PE of distal lesions in patients who were diagnosed as having UC.

Methods

This study involved 105 patients in whom UC was clinically and pathological diagnosed following the first episode at our university hospital, gastroenterology department between April 2006 and March 2009. For determining the study outcome, we looked at the proportion of patients with proximal extension during the follow-up period, disease progression as reflected by the rate of surgery, the need for hospitalisation, and refractoriness to medical interventions.

Results

The median follow-up period was 43 month (interquartile range [IQR] 36–51 months). At the time of UC diagnosis, disease extension in the 105 patients were as follows: Proctitis 28 (26.7%), left-side colitis 30 (28.6%), and extensive colitis or pancolitis 47 (44.8%). PE had occurred in 20 (34.5%) of 58 patients with proctitis and left-sided colitis during the follow-up period. There was no significant difference in the rate of disease progression between proctitis and left-sided colitis, 35.7% vs 33.3% (p = 1.0). In patients with disease progression (n = 20), mean time (standard deviation) for progression was 31.5 (16.8) months, range 6–65 months. In these 20 patients, the rates of surgery, hospitalisation, and refractory to medication requiring systemic steroid administration were significantly higher as compared with the patients with stable or regression in disease location, the rates of surgery, 30% vs 0% (p = 0.001); hospitalisations, 35% vs 5.3% 
(p = 0.0056); refractory to medication, 55% vs 18.4% (p = 0.0069); and systemic steroid administration, 70% vs 23.7 (p = 0.0015). No specific factor was found to be associated with disease progression.

Conclusion

The outcome of the present study indicated that the risk of proximal extension of distal UC is a reality. Up to 65% of proximal extensions were found to occur within 3 years of the first UC episode. These results may suggest a need for periodic assessment of disease extension and decision making on medical interventions at an early stage.