Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2021; 13(9): 407-415
Published online Sep 16, 2021. doi: 10.4253/wjge.v13.i9.407
Clinical characteristics and prognosis of patients with ulcerative colitis that shows rectal sparing at initial diagnosis
Yong-Sung Choi, Jong-Kyu Kim, Wan-Jung Kim
Yong-Sung Choi, Department of Internal Medicine, Daehang Hospital, Seoul 06699, South Korea
Jong-Kyu Kim, Wan-Jung Kim, Department of Gastroenterology, Daehang Hospital, Seoul 06699, South Korea
Author contributions: Choi YS designed the research study and wrote the manuscript; Kim JK and Kim WJ analyzed the data; all authors have read and approve the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Daehang Hospital on Feb 13, 2021 (Approval No. DH21-0001).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors disclosed no conflict of interest or financial relationships relevant to this publication.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at [yschoi427@naver.com]. Participants gave informed consent for data sharing.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong-Sung Choi, MD, Chief Doctor, Director, Staff Physician, Department of Internal Medicine, Daehang Hospital, 2151 Nambu Beltway, Seocho-Gu, Seoul 06699, South Korea. yschoi427@naver.com
Received: April 19, 2021
Peer-review started: April 19, 2021
First decision: June 13, 2021
Revised: June 23, 2021
Accepted: August 12, 2021
Article in press: August 12, 2021
Published online: September 16, 2021
Abstract
BACKGROUND

Ulcerative colitis (UC) is characterised by mucosal inflammation from the rectum to its proximal area in a symmetric and continuous fashion. However, although uncommon, we encounter cases of UC with rectal sparing in the initial stage.

AIM

To evaluate the clinical characteristics and clinical course for rectal sparing UC compared with typical UC.

METHODS

We looked at records from 2004 to 2015, and selected patients who were newly diagnosed with UC, and who could be followed up for at least 5 years in our hospital. We then retrospectively analysed the medical records and endoscopic findings of those patients. To compare the clinical course and prognosis, we matched each patient with rectal sparing UC 1:3 with controls by age, sex, and disease extent.

RESULTS

Of 619 UC patients, 24 (3.9%) showed rectal sparing at diagnosis. During the follow-up period (median 8 years), in two (8.3%) of the 24 patients, rectal sparing remained through follow-up inspections; but for the other 22 (91.7%) patients, obvious rectal inflammation was found at follow-up endoscopy. Of the 24 patients, 8 (33.3%) were initially misdiagnosed with infectious colitis. No diagnosis was changed to Crohn’s disease. The uses of corticosteroid or biologic agents, hospitalisation rate, and colectomy rates were not different between the rectal sparing UC group and typical UC group.

CONCLUSION

Some patients with UC can reveal atypical patterns of disease distribution, such as rectal sparing in its initial stage; but despite this, the clinical course and prognosis may not differ from those of typical UC patients.

Keywords: Ulcerative colitis, Rectal sparing, Clinical characteristics, Prognosis, At diagnosis, Adult

Core Tip: Ulcerative colitis (UC) is characterised by mucosal inflammation from the rectum to its proximal area in a symmetric and continuous fashion. However, the atypical distribution of UC, such as skip inflammation or rectal sparing can be encountered at initial stage, making diagnosis difficult in usual practice although it is uncommon. As a matter of fact, some studies concerning pediatric UC patients were reported, but its clinical significance and incidence is not known well in adult UC patients. Our study is the only study that evaluated the clinical characteristics and prognosis of adult rectal sparing-typed UC compared with typical UC.