INTRODUCTION: Long-term outcomes of patients with ulcerative proctitis (UP) have been poorly investigated, since these patients are excluded from participation in randomized controlled clinical trials. OBJECTIVE: The aim of this study was to investigate the prognostic and therapeutic long-term outcomes of patients with UP. METHODS: A retrospective study of patients with UP followed at our referral centre between 1 January 1998 and 1 January 2019 was performed. Treatment success was defined as clinical response (significant improvement in UP-related symptoms) and endoscopic response (mayo endoscopic sub-score of 0 or 1) if available at last follow-up. RESULTS: From a total of 1561 patients with ulcerative colitis, 118 patients with UP were identified. A total of 36 (31%) patients were refractory to rectal and oral therapy with 5-ASA and corticosteroids, necessitating azathioprine as monotherapy in 19 (16%) patients and/or biological therapies in 33 (28%) patients. After a median follow-up of 71 months (interquartile range 29-149 months), treatment success was observed in 103/118 (87%) UP patients and in 25/36 (69%) patients with refractory UP. Clinical response rates were significantly higher for refractory UP patients treated with biologicals (23/33; 70%) compared to ones treated with azathioprine (2/19; 11%; p = 0.001). CONCLUSION: Good clinical outcomes were recorded in UP, with treatment success in 87% of patients. Nevertheless, 28% needed escalation to biologicals. Long-term outcome in patients on biologicals was superior to azathioprine.
INTRODUCTION: Long-term outcomes of patients with ulcerative proctitis (UP) have been poorly investigated, since these patients are excluded from participation in randomized controlled clinical trials. OBJECTIVE: The aim of this study was to investigate the prognostic and therapeutic long-term outcomes of patients with UP. METHODS: A retrospective study of patients with UP followed at our referral centre between 1 January 1998 and 1 January 2019 was performed. Treatment success was defined as clinical response (significant improvement in UP-related symptoms) and endoscopic response (mayo endoscopic sub-score of 0 or 1) if available at last follow-up. RESULTS: From a total of 1561 patients with ulcerative colitis, 118 patients with UP were identified. A total of 36 (31%) patients were refractory to rectal and oral therapy with 5-ASA and corticosteroids, necessitating azathioprine as monotherapy in 19 (16%) patients and/or biological therapies in 33 (28%) patients. After a median follow-up of 71 months (interquartile range 29-149 months), treatment success was observed in 103/118 (87%) UP patients and in 25/36 (69%) patients with refractory UP. Clinical response rates were significantly higher for refractory UP patients treated with biologicals (23/33; 70%) compared to ones treated with azathioprine (2/19; 11%; p = 0.001). CONCLUSION: Good clinical outcomes were recorded in UP, with treatment success in 87% of patients. Nevertheless, 28% needed escalation to biologicals. Long-term outcome in patients on biologicals was superior to azathioprine.
Authors: G Meucci; M Vecchi; M Astegiano; L Beretta; P Cesari; P Dizioli; L Ferraris; M R Panelli; A Prada; R Sostegni; R de Franchis Journal: Am J Gastroenterol Date: 2000-02 Impact factor: 10.864
Authors: Walter Reinisch; William J Sandborn; Daniel W Hommes; Geert D'Haens; Stephen Hanauer; Stefan Schreiber; Remo Panaccione; Richard N Fedorak; Mary Beth Tighe; Bidan Huang; Wendy Kampman; Andreas Lazar; Roopal Thakkar Journal: Gut Date: 2011-01-05 Impact factor: 23.059
Authors: S Lindgren; R Löfberg; L Bergholm; M Hellblom; L Carling; K A Ung; R Schiöler; P Unge; C Wallin; M Ström; T Persson; O B Suhr Journal: Scand J Gastroenterol Date: 2002-06 Impact factor: 2.423
Authors: Brian G Feagan; Paul Rutgeerts; Bruce E Sands; Stephen Hanauer; Jean-Frédéric Colombel; William J Sandborn; Gert Van Assche; Jeffrey Axler; Hyo-Jong Kim; Silvio Danese; Irving Fox; Catherine Milch; Serap Sankoh; Tim Wyant; Jing Xu; Asit Parikh Journal: N Engl J Med Date: 2013-08-22 Impact factor: 91.245