Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.
Department of Gastroenterology and Hepatology. Antwerp University Hospital, Edegem, Belgium.
United European Gastroenterol J. 2020 Oct;8(8):933-941. doi: 10.1177/2050640620941345. Epub 2020 Jul 6.
Long-term outcomes of patients with ulcerative proctitis (UP) have been poorly investigated, since these patients are excluded from participation in randomized controlled clinical trials.
The aim of this study was to investigate the prognostic and therapeutic long-term outcomes of patients with UP.
A retrospective study of patients with UP followed at our referral centre between 1 January 1998 and 1 January 2019 was performed. Treatment success was defined as clinical response (significant improvement in UP-related symptoms) and endoscopic response (mayo endoscopic sub-score of 0 or 1) if available at last follow-up.
From a total of 1561 patients with ulcerative colitis, 118 patients with UP were identified. A total of 36 (31%) patients were refractory to rectal and oral therapy with 5-ASA and corticosteroids, necessitating azathioprine as monotherapy in 19 (16%) patients and/or biological therapies in 33 (28%) patients. After a median follow-up of 71 months (interquartile range 29-149 months), treatment success was observed in 103/118 (87%) UP patients and in 25/36 (69%) patients with refractory UP. Clinical response rates were significantly higher for refractory UP patients treated with biologicals (23/33; 70%) compared to ones treated with azathioprine (2/19; 11%; = 0.001).
Good clinical outcomes were recorded in UP, with treatment success in 87% of patients. Nevertheless, 28% needed escalation to biologicals. Long-term outcome in patients on biologicals was superior to azathioprine.
溃疡性直肠炎（UP）患者的长期预后情况研究较少，因为这些患者被排除在随机对照临床试验之外。
本研究旨在探讨 UP 患者的预后和长期治疗结果。
对 1998 年 1 月 1 日至 2019 年 1 月 1 日期间在我们的转诊中心接受治疗的 UP 患者进行回顾性研究。如果在最后一次随访时可获得临床缓解（UP 相关症状明显改善）和内镜缓解（Mayo 内镜评分 0 或 1），则将其定义为治疗成功。
在总共 1561 例溃疡性结肠炎患者中，发现 118 例 UP 患者。共有 36 例（31%）患者对直肠和口服 5-ASA 和皮质类固醇治疗无反应，需要硫唑嘌呤单药治疗 19 例（16%）患者和/或生物治疗 33 例（28%）患者。在中位数为 71 个月（29-149 个月）的随访后，118 例 UP 患者中有 103 例（87%）和 36 例难治性 UP 患者中有 25 例（69%）观察到治疗成功。接受生物治疗的难治性 UP 患者的临床缓解率（23/33；70%）明显高于接受硫唑嘌呤治疗的患者（2/19；11%；P=0.001）。
在 UP 中记录了良好的临床结局，87%的患者治疗成功。然而，仍有 28%的患者需要升级为生物治疗。接受生物治疗的患者的长期结局优于硫唑嘌呤。
