Factors associated with mesalamine refractory ulcerative proctitis requiring advanced medical treatments

BACKGROUND: Ulcerative proctitis (UP) is a subtype of ulcerative colitis (UC) affecting the rectum, usually manageable with mesalamine. However, a subgroup of patients is refractory to mesalamine, necessitating advanced therapies. We aimed to assess risk factors for refractory disease. MATERIALS AND METHODS: Data on proctitis patients were collected retrospectively from a single tertiary center during 2010-2024. Proctitis was defined as maximal disease extent of 20 cm from the anal verge. Patients treated with immunomodulators and/or biological therapy were considered to have refractory proctitis. Multivariable logistic regression analysis was used to identify risk factors. CONCLUSIONS: The use of topical steroids and endoscopic disease severity at diagnosis were associated with refractory proctitis. These results may help stratify patients who could benefit from closer, tailored monitoring strategies.