Clinical Predictors and Natural History of Disease Extension in Patients with Ulcerative Proctitis

Abstract

Background A proportion of patients with initial presentation of ulcerative proctitis (UP) progress to more extensive colitis. We sought to characterize the natural history and identify clinical predictors of extension in UP. Methods We performed a retrospective cohort study of participants with a new diagnosis of UP from January 2000 to December 2015. We used cox proportional hazard modeling to identify predictors of disease extension. Results Through December of 2015, we identified 169 cases of UP with a median age of diagnosis of 40 years (range: 16–91 years) and a median follow up of 4.3 years (range: 3.3–15.1 years). 53 (31%) patients developed extension over the follow up time. Compared to non-extenders, the need for immunosuppressive or biologic therapy was significantly higher among extenders (34% vs. 2.6%, p < 0.001). In multivariable analyses, compared to UP cases with BMI < 25, the adjusted hazard ratios (aHRs) of extension were 1.75 (95% CI, 0.95 – 3.23) and 2.77 (95% CI, 1.07 – 7.14) among overweight and obese patients, respectively (Ptrend = 0.03). Similarly, patients with a history of appendectomy or endoscopic finding of moderate to severe disease had a higher risk of extension (aHR = 2.74, 95% CI 1.07 – 7.01 and 1.96, 95% CI 1.05–3.67, respectively). Conclusion In a retrospective cohort study, we show that appendectomy, BMI, and endoscopic activity at the time of diagnosis of proctitis are associated with increased risk of extension. In addition, our data suggest that extenders are more likely to require immunosuppressive or biologic therapy.

The natural history and longitudinal outcomes of patients with mild-to-moderate ulcerative proctitis or ulcerative proctosigmoiditis: a single-center, retrospective study

“…BMI, endoscopic disease severity, appendectomy, and smoking are risk factors for the extension of UP according to previous results [10,13]. In our study, we found out that the severity of the disease is also correlated with the cumulative disease extension rate, which is consistent with previous research [13]. Besides, we also observed a higher extension rate in symptomatic patients.…”

“…Risk factors of disease extension were also analyzed in previous studies [10,13]. BMI, endoscopic disease severity, appendectomy, and smoking are risk factors for the extension of UP according to previous results [10,13]. In our study, we found out that the severity of the disease is also correlated with the cumulative disease extension rate, which is consistent with previous research [13].…”

“…Our study has several strengths. Firstly, the sample size of our study was relatively large compared with previous retrospective studies on UP and UPS [3,13], providing convincing results and limiting possible bias. Secondly, the relatively long follow-up period contributes to a more accurate evaluation of the longterm risks of UP and UPS.…”

“…A higher proximal extension rate of around 27% was observed in a previous study evaluating the natural history of ulcerative proctitis with a median follow-up period of 68 months [10]. In another study of UP, 31% of patients of UP developed disease extension [13]. The inconsistent result is probably caused by different inclusion criteria.…”

Clinical Features and Outcomes of Paediatric Patients With Isolated Colonic Crohn Disease

“…As an example, in the IBSEN cohort, 42% of patients with UP had proximal disease extension (28% to left-sided, 14% to extensive colitis) 31 . Meucci and colleagues reported that a more severe phenotype (recurrent flares, need for systemic steroids, or patients with chronically active disease), or lack of smoking were associated with progression of inflammation 11 , while in a different study appendectomy and obesity were associated with such a phenotype 32 . Our data indicate that two factors at the end of induction, including a high PUCAI score and lack of steroid-free clinical remission, were associated with progression.…”