Natural history and progression risk factors of ulcerative proctitis: a retrospective study from a single tertiary centre in Poland

Introduction
Ulcerative proctitis is a chronic disease, characterized by lower risk of complications and less aggressive treatment in comparison to other forms of ulcerative colitis. Therefore, the key issue is to predict the natural course of the disease and protect against proximal spread of inflammatory lesions in the future.

Aim
To identify risk factors for progression of ulcerative proctitis and investigate the natural history of the disease.

Material and methods
We performed a retrospective study and included patients with ulcerative proctitis, diagnosed between January 2010 and December 2020, who suffered from ulcerative proctitis for at least 1 year. The collected data were then subjected to statistical analysis.

Results
We identified 116 cases of ulcerative proctitis in patients aged between 19 and 84 years. Proximal extension of the disease occurred in 65 (56%) people – left sided colitis developed in 55 (85%) and pancolitis in 10 (15%) patients. We detected many progression risk factors of ulcerative proctitis, among which the most meaningful were Mayo Endoscopic Score at levels 2 and 3 at onset (p < 0.05), high stress level (p < 0.05), more than one exacerbation in the first year of the disease (p < 0.05), and the use of systemic glucocorticosteroids during exacerbations in mild-to-moderate activity of the disease (p < 0.05).

Conclusions
According to our study, early identification of progression risk factors in ulcerative proctitis is crucial for the future outcomes of the disease. The proper treatment at onset is relevant in preventing the progression of inflammatory lesions and the development of disease complications.