P124 The bottom line on ulcerative proctitis: an 11-year analysis of patient outcomes from a UK teaching hospital
Bibliographic record
Abstract
Introduction Ulcerative proctitis (UP), is a localized manifestation of ulcerative colitis (UC) confined to the rectum.1 Between 25–55% of patients diagnosed with UC initially present with UP.2Patients with UP exhibit more favourable prognoses compared to those with extensive UC though up to 30% of those with UP progress to more extensive colitis over time.3 This retrospective analysis explores the clinical trajectories of patients with UP referred to a UK teaching hospital over 11 years. Methods This study retrospectively identified patients diagnosed with UP between 2012 and 2023 at a medium-sized UK teaching hospital. Patient data, extracted from electronic health records, were analysed using descriptive statistics. Results We identified 176 patients with UP (56% male), with a median diagnostic age of 56.5 years (IQR, 43–76). The median follow-up period was 3.5 years (IQR, 1–7). At diagnosis, 13.4% (n=23) were active smokers. Endoscopic severity was classified as mild in 67 cases (62.6%) and moderate to severe in 60 (56%) of the 107 patients with available data. As initial management, 41 patients (23.2%) received topical 5-ASA, 85 (48.3%) received oral 5-ASA, 10 (5.6%) received topical steroids, and 27 (15.3%) no treatment. Treatment escalation was required for 30 patients (17.0%), with a median time from diagnosis to escalation of 12 months (IQR, 12–24). 23 patients (13.1%) had azathioprine, and 18 (10.2%) required biologics, with 4 (2.2%) needing second-line biologics. The specific biologics used were infliximab (n=7), vedolizumab (n=6), adalimumab (n=2), golimumab (n=2), and ustekinumab (n=1). Four patients (2.2%) underwent surgical resection. A total of 71 patients (40%) were discharged back to primary care after a median follow-up of 18.5 months (IQR, 8–48), and 3 (1.7%) were referred back to secondary care. Conclusion UP predominantly exhibits a mild clinical course, with a significant proportion of patients responding adequately to first-line therapy. Our findings suggest that patients with stable UP, adequately managed on 5-ASA, could be discharged to primary care after 12–18 months’ follow-up. Future research should focus on identifying predictors of 5-ASA failure in UP. References Satsangi J, Silverberg MS, Vermeire S, et al. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut 2006;55:749–753. Meucci G, Vecchi M, Astegiano M, et al. The natural history of ulcerative proctitis: a multicenter, retrospective study. Am J Gastroenterol 2000;95:469–473. Kim B, Park SJ, Hong SP, et al. Proximal disease extension and related predicting factors in ulcerative proctitis. Scand J Gastroenterol. 2014 Feb;49(2):177–83.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".