Management of Patients with Ulcerative Proctitis: A Global Survey

BACKGROUND AND AIM: Ulcerative proctitis affects approximately 30% of patients with ulcerative colitis. Disease control is essential to maintain quality of life and to prevent disability and disease progression. The aim of this study was to investigate current practice on isolated proctitis management across the globe.

Physicians with experience in treating inflammatory bowel diseases (IBD) were invited to participate in an anonymous, multiple-choice survey between January and February 2025.

The survey included 460 physicians from 66 countries. Most participants (87.9%) assessed clinical activity of isolated proctitis within 3 months of treatment initiation, 75.9% used fecal calprotectin, and 67.1% used C-reactive protein to measure disease activity. Endoscopic assessment was performed 3 to 6 months (34.2%) or 6 to 12 months (48.4%) after treatment induction. In this survey, 49% of participants were more reluctant to begin an advanced therapy in patients with isolated proctitis compared to pancolitis or left-sided colitis. About two-thirds of participants were less likely to use biologics in combination with immunosuppressants in isolated proctitis compared to left-sided or pancolitis. Anti-TNF (tumor necrosis factor) was the preferred choice in first-line advanced therapy after failing conventional treatment (48.4%).

This study highlighted differences in management of isolated proctitis compared to left-sided colitis or pancolitis. This is likely explained by the fact that isolated proctitis patients were historically excluded from clinical trials; therefore, management relied on extrapolation of data from studies on more extensive disease.