The natural history of ulcerative proctitis: A multicenter, retrospective study

OBJECTIVE: The aim of this study was to evaluate the clinical features and the long term evolution of patients with a well defined initial diagnosis o f ulcerative proctitis. METHODS: Patients with an original diagnosis of ulcerative proctitis who ha d been seen at any of 13 institutions from 1989 to 1994 were identified. Da ta on disease onset and subsequent evolution were recorded. In addition, 57 5 patients with more extensive disease, treated in the same centers, were u sed as controls. RESULTS: A total of 341 patients satisfied the inclusion criteria. The perc entage of smokers in these patients was slightly lower than in controls; no differences were found in the other clinical/demographic variables evaluat ed. A total of 273 patients entered long term follow-up (mean, 52 months). Proximal extension of the disease occurred in 74 of them (27.1%). The cumul ative rate of proximal extension and of extension beyond the splenic flexur e was 20% and 4% at 5 yr and 54% and 10% at 10 yr, respectively. The risk o f proximal extension was higher in nonsmokers, in patients with >3 relapses /yr, and in patients needing systemic steroid or immunosuppressive treatmen t. Refractory disease was confirmed as an independent prognostic factor at multivariate analysis. CONCLUSIONS: Proximal extension of ulcerative proctitis is frequent and may occur even late after the original diagnosis. However, the risk of extensi on beyond the splenic flexure appears to be quite low. Smoking seems to be a protective factor against proximal extension, whereas refractoriness is a risk factor for proximal extension of the disease. (C) 2000 by Am. Cell. o f Gastroenterology.