Background: Although the course of ulcerative proctitis in adults has
been well described, little data are available concerning its clinical
behavior in children and adolescents. This study sought to characteri
ze the presentation, response to therapy, and long-term course of ulce
rative proctitis in the pediatric population. Methods: A retrospective
chart review was conducted at five pediatric gastroenterology centers
. Results: A total of 38 subjects (mean age 11.6 years) were identifie
d with ulcerative proctitis (mean follow-up 4.3 years). Symptoms were
mild at diagnosis in 74% and moderate or severe in 26%. Thirty-two per
cent had a complaint of constipation at presentation. Cessation of sym
ptoms was noted in 68% within 3 months of therapy, an additional 24% w
ithin 6 months, and 8% were still symptomatic despite 6 months of ther
apy. During any subsequent yearly follow-up interval, similar to 55% o
f patients were asymptomatic, 40% had a chronic intermittent course, a
nd <5% were continuously symptomatic despite therapy. Eight subjects w
ere treated with oral corticosteroids, one with B-mercaptopurine, and
one with cyclosporine. Extension of inflammation proximal to the recto
sigmoid occurred in 11 of 38 subjects (29%), 0.5-11.3 years postdiagno
sis. Seven of the 13 subjects (54%) followed for greater than or equal
to 5 years had proximal extension of disease, and two had undergone c
olectomy. Conclusions: Despite a mild presentation in most subjects, u
lcerative proctitis seems to have a high risk of proximal extension of
disease. The overall response to therapy seems to be similar to that
reported for ulcerative colitis in children. Follow-up endoscopic eval
uation of patients with ulcerative proctitis seems warranted, especial
ly in the setting of recurrent or recalcitrant symptoms.