https://orcid.org/0000-0002-7421-9764
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Esther Y Liu, Anjile An, Shaira Khan, Robert Battat, Randy Longman, Ellen Scherl, Laura Sahyoun, Dana J Lukin, JRI Live Cell Bank Consortium , The Impact of Endoscopic Healing on Disease-Related Outcomes in Patients With Ulcerative Proctitis, Inflammatory Bowel Diseases, 2025;, izaf044, https://doi.org/10.1093/ibd/izaf044
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Abstract
Ulcerative proctitis (UP) is a limited form of ulcerative colitis. While achieving endoscopic healing (EH) in ulcerative colitis improves long-term outcomes, the benefit of EH in UP is uncertain. This study aimed to assess the impact of EH on outcomes in UP.
This single-center retrospective study included adults with UP and ≥2 endoscopies, with active inflammation (Mayo endoscopic score [MES] 1-3) at index. EH was defined as MES 0-1 at follow-up procedure. The relationship of EH to inflammatory bowel disease (IBD)-related outcomes was assessed using univariate analysis and multivariable logistic regression assessed the effect of EH on IBD-related outcomes.
Among 200 UP patients, 109 (54.5%) had EH at follow-up endoscopy at median 19 months (interquartile range: 7, 32). EH was associated with fewer IBD-related emergency department (ED) visits (EH: 8.3%, no EH: 21%, P = .01), hospitalizations (5.5% vs 18%), and GI visits (mean: 1.47/year [SD: 1.40], vs 2.96/year [2.52], P < .001). Patients with EH were less likely to have iron deficiency anemia (23% vs 41%, P = .007), Clostridioides difficile (0.9% vs 6.6%, P = .048), or initiate new biologic therapy after relapse (15% vs 33%, P = .034). Patients with EH had a greater time to clinical relapse (21 [24] vs 9 months [14]; P = .006) and lower odds of an IBD-related ED visit (OR: 0.32, 95% CI: 0.13, 0.73) or hospitalization (0.26 [0.09, 0.67]). Baseline presence of a cecal patch did not impact outcomes.
UP patients with EH had less IBD-related healthcare utilization, fewer IBD-related complications, and were less likely to escalate therapy after relapse than patients without EH. Using a treatment target of EH may therefore be desirable in UP.
Lay Summary
Compared with extensive ulcerative colitis (UC), ulcerative proctitis (UP) is associated with limited risks. We assessed the importance of the key treat-to-target endpoint endoscopic healing (EH) on UP outcomes. EH was associated with lower inflammatory bowel disease (IBD)-related healthcare utilization and IBD-related complications., suggesting this target applies to UP in addition to more extensive UC.
