Factors associated with mesalamine refractory ulcerative proctitis requiring advanced medical treatments.

BACKGROUND

Ulcerative proctitis (UP) is a subtype of ulcerative colitis (UC) affecting the rectum, usually manageable with mesalamine. However, a subgroup of patients is refractory to mesalamine, necessitating advanced therapies. We aimed to assess risk factors for refractory disease.

MATERIALS AND

METHODS

Data on proctitis patients were collected retrospectively from a single tertiary center during 2010-2024. Proctitis was defined as maximal disease extent of 20 cm from the anal verge. Patients treated with immunomodulators and/or biological therapy were considered to have refractory proctitis. Multivariable logistic regression analysis was used to identify risk factors.

RESULTS

We included 230 patients in the analysis, of whom 50 (21.7%) patients had refractory disease. At diagnosis, refractory patients were younger (25.0 years [20.0-32.0] vs. 30.5 years [22.5-41.0], p = 0.008), had longer disease extent (12.37 cm ± 5.81 vs. 9.87 cm ± 5.40, p = 0.018), had more severe endoscopic activity (Mayo endoscopic score [MES] 2/3: 21 [87.5%] vs. 45 [59.2%], p = 0.025) and more often used rectal steroids (24 [48.9%] vs. 31 [17.3%], p = 0.009). There was no difference between groups in sex, BMI, smoking status, presence of cecal patch, use of rectal 5-ASA or follow-up duration. In the multivariable regression model, the only significant predictors were use of topical steroids (odds ratio 4.0, 95% CI 1.13-14.13, p = 0.031) and baseline endoscopic severity (odds ratio 5.23, 95% CI 1.04-26.27, p = 0.044).

CONCLUSIONS

The use of topical steroids and endoscopic disease severity at diagnosis were associated with refractory proctitis. These results may help stratify patients who could benefit from closer, tailored monitoring strategies.