P0233Ulcerative Proctitis: A 2 year retrospective review of adherence to Guidelines in managing proctitis and achievement of clinical, biochemical and endoscopic remission.

Background Ulcerative colitis is a chronic inflammatory condition of the colonic mucosa. Repeated flares are common. The extent of affected mucosa may vary from the original phenotype. We aimed to review clinician adherence to British Society of Gastroenterology (BSG) guidelines in the management of patients with active proctitis identified on colonoscopy/sigmoidoscopy in a tertiary hospital outpatient setting. The secondary objective was to evaluate rates of biochemical, clinical and endoscopic remission at 6-18 months post-endoscopy. Methods Retrospective data was collected from a single Australian tertiary centre over a 2-year period between 2022 to 2024. All patients over 18 years of age with proctitis were included, regardless of previous phenotype. A review of the electronic medical system was then conducted to determine if management was in line with BSG guidelines. Evidence of biochemical, clinical and/or endoscopic remission at 6-18 months post endoscopy finding was also reviewed. Clinical remission was defined as SCCAI score <2, endoscopic remission was defined as UCEIS score of ≤ 1 and biochemical remission was defined as faecal calprotectin ≤ 100. Results 875 colonoscopies and/or sigmoidoscopies were identified for patients with underlying ulcerative colitis. Of these, 165 scopes showed active proctitis. Exclusion of inpatient and repeat procedures resulted in a total analysis of 119 patients (Figure 1). Fifty-two percent of patients (n = 63) were treated in line with current BSG Guidelines. Eighty-one percent (96 of 119) of the patients reported clinical remission within 1 year. Biochemical remission was confirmed in 83% of patients who had a follow up faecal calprotectin in that time (n = 96). Of the 119 patients, sixty-eight (57.1%) patients were assessed for endoscopic remission within 18 months with thirty-six (52%) having confirmed endoscopic remission. We did not find a statistically significant correlation between the achievement of clinical, biochemical or endoscopic remission and adherence to BMJ guidelines (p = > 0.05) Conclusion Adherence to BSG guidelines was observed in 52% of cases, highlighting significant variability in the management of proctitis in an outpatient setting. A substantial proportion of patients reported complete clinical and biochemical remission within the 18 months. A relatively lower rate of confirmed endoscopic remission, suggests that patients with proctitis may be undertreated. Conflict of interest: Malkopoulos, Athanasios: No conflict of interest Kakkadasam Ramaswamy, Pradeep: No conflict of interest Subhaharan, Deloshaan: No conflict of interest James, Rayschelle: No conflict of interest Mohsen, Waled: No conflict of interest