P4345 - The Cecal Patch in Ulcerative Proctitis – A Harbinger of Disease Progression or Merely an Incidental Finding?

Laura Sahyoun, MD¹, Esther Liu, MD², Robert Battat, MD³, Randy Longman, MD, PhD⁴, Ellen Scherl, MD¹, Dana J. Lukin, MD^5
1New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY; ²New York-Presbyterian / Weill Cornell Medical Center, New York, NY; ³Centre Hospitalier de l'Université de Montréal, Montreal, PQ, Canada; ⁴Weill Cornell Medicine, New York, NY; ⁵Jill Roberts Center for Inflammatory Bowel Disease, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY

Introduction: Ulcerative colitis classically consists of immune-mediated inflammation that is present in the rectum and can extend proximally in a continuous matter. Isolated rectal inflammation, or ulcerative proctitis, represents a limited form of disease that is not associated with increased risk of dysplasia. Existing literature is sparse and conflicting on the significance of peri-appendiceal inflammation, or a “cecal patch”, in otherwise isolated proctitis. Our aim was to assess if the presence of a cecal patch carried a higher risk of disease progression or complications.

Methods: This is a single-center retrospective study of adult patients with ulcerative proctitis treated from 1/2002 to 4/2023. Patients were included in the study if they had a minimum of two endoscopic evaluations, with index colonoscopy showing Mayo Endoscopic Score (MES) with active disease (≥1) that was limited to the rectum (extent ≤ 20 cm). Endoscopic healing was defined as MES 0 or 1 on follow up endoscopy. Statistical significance was calculated using Chi-square for categorical variables and independent T-test for quantitative variables.

Results: Of the 200 patients with isolated proctitis, 25 had a cecal patch present at index colonoscopy. Between those with a cecal patch and those without, there were no significant differences in patient demographics, baseline inflammatory marker values (C-reactive protein and fecal calprotectin), or baseline medication use (steroids, mesalamine, immunomodulator or biologic agents). In univariate analysis, the presence of a cecal patch was not significantly associated with proximal extension of disease (p=0.699). In multivariate analysis adjusting for age, sex, race/ethnicity, and index MES score, cecal patch was not a significant risk factor for proximal extension, the need for medical therapy change or escalation, or disease relapse (Table 1).

Discussion: Patients with ulcerative proctitis had similar rates of proximal extension, medical therapy escalation or disease relapse regardless of the presence of a cecal patch. This suggests that a cecal patch does not confer increased risk of disease progression.


Disclosures:


Laura Sahyoun, MD¹, Esther Liu, MD², Robert Battat, MD³, Randy Longman, MD, PhD⁴, Ellen Scherl, MD¹, Dana J. Lukin, MD⁵. P4345 - The Cecal Patch in Ulcerative Proctitis – A Harbinger of Disease Progression or Merely an Incidental Finding?, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.