Prognostic Value of Serologic and Histologic Markers on Clinical Relapse in Ulcerative Colitis Patients With Mucosal Healing

2012 ◽  
Vol 107 (11) ◽  
pp. 1684-1692 ◽  
Author(s):  
Talat Bessissow ◽  
Bart Lemmens ◽  
Marc Ferrante ◽  
Raf Bisschops ◽  
Kristel Van Steen ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Prognostic Value ◽  
Mucosal Healing ◽  
Clinical Relapse

scholarly journals P696 The usefulness to treatment enhancement for the patients of ulcerative colitis with clinical remission diagnosed as Mayo endoscopic subscore 1

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S564-S564
Author(s):  
M Kubota Kajiwara ◽  
K Uchiyama ◽  
Y Azuma ◽  
R Yasuda ◽  
S Takayama ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Treatment Group ◽  
Clinical Remission ◽  
Clinical Symptoms ◽  
Mucosal Healing ◽  
Endoscopic Examination ◽  
Clinical Relapse ◽  
Oral Medicine ◽  
Clinical Background ◽  
Observation Period

Abstract Background In many clinical trials of ulcerative colitis (UC), Mayo endoscopic subscore (MES) has been used to diagnose mucosal healing to evaluate the effectiveness of various treatment. Although both MES 0 and MES 1 were defined as the endoscopic mucosal healing, several studies reported that the risk of clinical relapse was significantly higher in the patients diagnosed as MES 1 compared with MES 0. However, it has not been established the beneficial effect to escalate the treatment for the patients diagnosed as MES 1 to avoid clinical relapse. In the present study, we retrospectively investigated the effectiveness about the escalation of treatment for UC patients with clinical remission diagnosed as MES 1. Methods A total of 68 patients with UC diagnosed as clinical remission (4 and under of Lichtiger CAI score) between April 2014 to October 2019 were enrolled in this study. All patients were endoscopically diagnosed as MES 1 and observation period was 12 months from the time of endoscopy. Relapse of UC was defined as the need for more aggressive treatment for UC due to aggravation of clinical symptoms or endoscopic findings. The relapse ratio was compared between the patients who continued the same treatment and the patients who had enhanced treatment. Enhanced treatment was defined as additional oral medicine or local preparations including enemas, suppositories, and foams within 3 months from endoscopic examination. Results In 68 patients, 12 patients were received enhanced treatment and 56 patients were continued the same treatments. There were no significant differences in clinical background between the two groups such as mean age (enhanced treatment group vs. same treatment group: 47.9 years vs. 42.9 years), disease type, disease duration (110.3 months vs. 94.8 months), and disease activity (Lichtiger CAI score: 2.5 vs. 2.8). The group of the enhanced treatment included 8 patients with oral 5-aminosalicylates escalation and 4 patients with additional local preparations. The relapse ratio was higher in patients with same treatment group (0%) compared with enhanced treatment group (14.3%). Conclusion Our results indicate that the enhancement of the treatment for UC patients with clinical remission diagnosed as MES 1 is effective to avoid relapse.

scholarly journals P335 Treatment strategies after mucosal healing (MH) in ulcerative colitis

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S323-S323
Author(s):  
A Sitibondo ◽  
A Viola ◽  
G Costantino ◽  
A Centritto ◽  
A Belvedere ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Demographic Data ◽  
Age At Onset ◽  
Treatment Strategies ◽  
Smoking Behaviour ◽  
Mucosal Healing ◽  
Rank Test ◽  
Clinical Relapse ◽  
Therapeutic Goals ◽  
Mean Time

Abstract Background MH and deep remission are the major therapeutic goals in the treatment of ulcerative colitis (UC), but the best therapeutic strategy after reaching MH in terms of maintenance or de-escalation is still poorly defined. This retrospective study aimed to evaluate the maintenance of remission in patients who maintained therapy vs. patients de-escalating treatment. Methods Data of patients with UC who reached mucosal healing were retrospectively investigated. Demographic data/gender, age), disease-related data (extension, duration, age at onset), together with data on smoking behaviour and on therapy after reaching MH were collected. MH was defined as an endoscopic Mayo score of 0. The primary endpoint was clinical relapse regardless of therapeutic regimen. The outcome of patients maintained on therapy was compared with patients who de-escalated therapy and to patients with mild disease maintained on mesalazine. Results One hundred thirty-five patients with MH were followed for a mean time of 94 months (SD 57.2) and divided into 3 groups: group 1 (de-escalation; 45 patients), in which MH was reached with IMM or biologics and therapy was continued with only mesalazine, group 2 (no de-escalation; 40 patients) in which MH was reached with IMM or biologics, group 3 (only treatment with 5-ASA; 50 patients). In the 3 groups, disease relapse occurred in 62%, 30% and 38% respectively in a mean time of 22, 25 and 36 months. Patients who de-escalated therapy were more likely to relapse than patients who maintained initial treatment (p = 0.003, log-rank test)(Figure 1). A subgroup analysis showed as only for MH reached with anti-TNFs de-escalation strategy was related to an increasing risk of relapse (p = 0.003). No risk factors for relapse were identified on multivariate analysis. Conclusion Maintaining treatment after MH is reached represents the best strategy to maintain remission. Patients on anti-TNFs were more likely to relapse after de-escalation. An evaluation on pharmacoeconomics seems to be advised in order to identify a more sustainable strategy.

Sa1199 Mucosal Healing in Ulcerative Colitis: Do Mayo 0 and 1 Scores Really Have the Same Prognostic Value? A Prospective Observational Cohort Study

2014 ◽  
Vol 146 (5) ◽  
pp. S-227-S-228
Author(s):  
Manuel Barreiro-de Acosta ◽  
Nicolau vallejo-Senra ◽  
Daniel De la Iglesia Garcia ◽  
Laura Uribarri-González ◽  
Iria Baston-Rey ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Cohort Study ◽  
Prognostic Value ◽  
Mucosal Healing ◽  
Observational Cohort Study ◽  
Prospective Observational Cohort Study ◽  
Observational Cohort

Mo1665 Prognostic Value of Serologic and Histologic Markers on Long-Term Outcomes in Ulcerative Colitis Patients With Mucosal Healing

2012 ◽  
Vol 142 (5) ◽  
pp. S-653 ◽  
Author(s):  
Talat Bessissow ◽  
Bart Lemmens ◽  
Marc Ferrante ◽  
Raf Bisschops ◽  
Karel Geboes ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Prognostic Value ◽  
Mucosal Healing ◽  
Long Term Outcomes

scholarly journals Histological Markers of Clinical Relapse in Endoscopically Quiescent Ulcerative Colitis

2019 ◽  
Vol 26 (11) ◽  
pp. 1722-1729 ◽  
Author(s):  
David Kevans ◽  
Richard Kirsch ◽  
Callum Dargavel ◽  
Boyko Kabakchiev ◽  
Robert Riddell ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Mucosal Healing ◽  
Mucosal Inflammation ◽  
Clinical Relapse ◽  
Disease Relapse ◽  
Mayo Score ◽  
Therapeutic Decisions ◽  
First Relapse ◽  
Histological Activity

Abstract Background In ulcerative colitis (UC) patients who have achieved mucosal healing, active microscopic colonic mucosal inflammation is commonly observed. We aimed to assess the association between histological activity and disease relapse in endoscopically quiescent UC. Methods Ulcerative colitis patients with endoscopically quiescent disease and ≥12 months of follow-up were included. Biopsies were reviewed for the presence of basal plasmacytosis (BPC) and active histological inflammation, defined as a Geboes score (GS) ≥3.2. Primary outcome measures were disease relapse at 18 months and time to first relapse after index colonoscopy. Results Seventy-six UC patients (51% male; mean age, 38.6 years; median follow-up [range], 75.2 [2–118] months) were included. Sixty-two percent had an endoscopic Mayo score of 0 at index colonoscopy. Basal plasmacytosis was present in 46% and active histological inflammation in 30% of subjects. Presence of BPC was associated with a significantly shorter time to disease relapse (P = 0.01). Active histological inflammation was significantly associated with clinical relapse at 18 months (P = 0.0005) and shorter time to clinical relapse (P = 0.0006). Multivariate analysis demonstrated active histological inflammation to be independently associated with clinical relapse at 18 months and time to clinical relapse. Conclusions In endoscopically quiescent UC, active histological inflammation and the presence of BPC are adjunctive histological markers associated with increased likelihood of disease relapse. Although prospective studies are required, the presence of these histological markers should be a factor considered when making therapeutic decisions in UC.

scholarly journals P118 A comprehensive evaluation of mucosal redness in patients with ulcerative colitis by linked colour imaging

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S195-S195
Author(s):  
K Uchiyama ◽  
M Kubota ◽  
Y Azuma ◽  
R Yasuda ◽  
T Shun ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
White Light ◽  
Clinical Symptoms ◽  
Comprehensive Evaluation ◽  
Mucosal Healing ◽  
Clinical Relapse ◽  
Light Image ◽  
Colon And Rectum ◽  
Long Term Prognosis ◽  
Relapse Group

Abstract Background Mucosal healing is important for the patients of ulcerative colitis (UC) to avoid clinical relapse and developing colitic cancer. Though Mayo endoscopic subscore (MES) has been widely used to evaluate mucosal healing of UC patients, it is not enough to predict relapse. We have reported the new endoscopic evaluation by linked colour imaging (LCI) that enhances mucosal redness and can predict relapse with more precision compared with MES1). However, the diagnosis in both MES and LCI depends on the local lesion and it has not been established the comprehensive evaluation because mucosal redness is not clearly recognised by white light image. In the present study, we examined the comprehensive evaluation of mucosal redness in the patients of UC by LCI and investigate the relation with long-term prognosis. Methods All examinations were carried out with an EG-L590WR endoscope and a LASEREO endoscopic system (FUJIFILM Co., Tokyo, Japan) including 47 UC patients (pan colitis type) with clinically remission (Under 4 of Lichtiger CAI score). Each part of the large intestine (ascending colon, transverse colon, descending colon, sigmoid colon and rectum) was observed with LCI and WLI (white light image), and the area of redness (regardless of strength) was evaluated. The score was marked 0, 1, 2 and 3, in case of the area of redness is 0%, <50%, 50% or higher and 100%, respectively. The score of each part was totalled (total redness score), and the relapse rate for 1 year after the endoscopy was investigated. Relapse of ulcerative colitis was defined as the need for more aggressive medication for ulcerative colitis due to aggravation or clinical symptoms, or aggravation of endoscopic findings. Results The relapse ratio was 19.1% (9/47 cases). The average of total redness score by LCI was 4.02 ± 2.25 and total redness score by WLI was 3.11 ± 2.5. The average of total redness score by LCI in the patients with no relapse group was 3.94 ± 2.21, on the other hand, with relapse group was 4.33 ± 2.23 (p = 0.0354). However, total redness score measured by WLI showed no statistical difference between no relapse group and relapse (p = 0.278). Conclusion A comprehensive evaluation of mucosal redness using LCI is useful approach to predict relapse for UC patients with clinical remission.

Effect of mucosal healing (Mayo 0) on clinical relapse in patients with ulcerative colitis in clinical remission

2016 ◽  
Vol 51 (9) ◽  
pp. 1069-1074 ◽  
Author(s):  
Jae Hyun Kim ◽  
Jae Hee Cheon ◽  
Yehyun Park ◽  
Hyun Jung Lee ◽  
Soo Jung Park ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Remission ◽  
Mucosal Healing ◽  
Clinical Relapse

scholarly journals P293 Histological risk factors to predict clinical relapse in ulcerative colitis in mucosal healing

2017 ◽  
Vol 11 (suppl_1) ◽  
pp. S226-S226
Author(s):  
R. Ozaki ◽  
T. Kobayashi ◽  
E. Saito ◽  
T. Toyonaga ◽  
S. Okabayashi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ulcerative Colitis ◽  
Mucosal Healing ◽  
Clinical Relapse
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