IBD Drive Time: Dana Lukin, MD, on Ulcerative Proctitis

So let's, let's just start out with some numbers.

So, um, what percentage, approximately what percentage of patients have isolated ulcerative proctitis?

So, uh, it's important to understand that when we, we talk about the extent of proctitis, that we're, we're talking about not only endoscopic involvement but, uh, also histologic, uh, first and foremost.

But, uh, um, most defini- most studies have cited, uh, somewhere between 20 and 55% of patients to have ulcerative, uh, proctitis.

Uh, if you look at the largest, uh, system- systematic review, uh, I- they found around, uh, 29 or 30%, um, in a, in a large number of populat- population-based studies.

So, uh, I usually cite around a third of patients a- at presentation.

And so this is less so with Crohn's disease.

Usually, location in Crohn's is pretty stable, but in ulcerative colitis, we know that patients can extend, and they can regress.

So of those patients that start out as ulcerative proctitis, what percent of them will have extent, will extend to develop left-sided disease or more extensive or pancolitis?

Um, so it's actually quite a bit more than you would think.

Uh, if you look at the ACG guideline, uh, they cite about 46% of patients that, that present with proctitis will eventually have more extensive disease on follow-up.

Um, this probably happens in stages.

Uh, about 10 to 20% are cited within the first five years, and then, uh, up to about 30% after 10 years.

So, um, you know, I think that there is a, a good amount of early extension, um, but, but some of this is happening even, even further out.

So if we wanna ...

I like keeping things simple, so if we wanna keep it simple, we could say about a third of patients are gonna have ulcerative proctitis, and about a third are gonna extend.