The Predictive Variable Regarding Relapse in Patients with Ulcerative Colitis After Achieving Endoscopic Mucosal Healing

Overview

Journal Intest Res

Date 2016 Feb 18

PMID 26884733

Citations 10

Authors

Takuya Yoshino

Kohei Yamakawa

Satoshi Nishimura

Koutaro Watanabe

Shujiro Yazumi

Affiliations

Soon will be listed here.

Abstract

Background/aims: Mucosal healing (MH) is a proposed therapeutic goal for patients with ulcerative colitis (UC). Whether MH is the final goal for UC, however, remains under debate. Therefore, to elucidate clinical variables predicting relapse after MH in UC could be useful for establishing further therapeutic strategy. The aim of this study is to evaluate the predictive variables for relapse in UC-patients after achieving MH.

Methods: From April 2010 to February 2015, 298 UC-patients treated at Kitano Hospital were retrospectively analyzed. MH was defined as Mayo endoscopic subscore of 0 or 1. The cumulative relapse free rate after achieving MH was evaluated. Predictive variables for relapse in UC-patients were assessed by Cox regression analysis.

Results: Of 298 UC-patients, 88 (29.5%) achieved MH. Of the 88 UC patients who achieved MH, 21 (23.9%) experienced UC-relapse. Based on Kaplan-Meier analysis, the cumulative relapse free rate at 1, 3, and 5 years after achieving MH was 87.9%, 70.2%, and 63.8%, respectively. The cumulative relapse free rate tended to be higher in the Mayo-0 group (76.9%) than in the Mayo-1 group (54.1%) at 5 years, although the difference was not statistically significant (P=0.313). Cox regression analysis indicated that the use of an immunomodulator was a predictive variable for relapse in UC-patients after achieving MH (P=0.035).

Conclusions: Our data demonstrated that the prognosis of UC patients after achieving endoscopic MH could be based on UC refractoriness requiring an immunomodulator.

Citing Articles

Deep mucosal healing in ulcerative colitis: how deep is better?.

Jin X, You Y, Ruan G, Zhou W, Li J, Li J Front Med (Lausanne). 2024; 11:1429427.

PMID: 39156693 PMC: 11327023. DOI: 10.3389/fmed.2024.1429427.

Predicting Ulcerative Colitis Relapse in Clinical Remission With Fecal Immunochemical Occult Blood Test or Prostaglandin E-Major Urinary Metabolite.

Ishida N, Matsuura T, Asai Y, Miyazu T, Tamura S, Tani S Clin Transl Gastroenterol. 2022; 13(7):e00501.

PMID: 35616320 PMC: 10476737. DOI: 10.14309/ctg.0000000000000501.

Systematic review and meta-analysis: the advantage of endoscopic Mayo score 0 over 1 in patients with ulcerative colitis.

Viscido A, Valvano M, Stefanelli G, Capannolo A, Castellini C, Onori E BMC Gastroenterol. 2022; 22(1):92.

PMID: 35240984 PMC: 8895505. DOI: 10.1186/s12876-022-02157-5.

Further research on the clinical relevance of the ulcerative colitis colonoscopic index of severity for predicting 5-year relapse.

Ishida N, Onoue S, Miyazu T, Tamura S, Tani S, Yamade M Int J Colorectal Dis. 2021; 36(12):2661-2670.

PMID: 34409500 PMC: 8589779. DOI: 10.1007/s00384-021-04009-2.

Association between serum folate with inflammatory markers, disease clinical activity and serum homocysteine in patients with inflammatory bowel disease. Does folate level have an effect on maintaining clinical remission?.

Moein S, Vaghari-Tabari M, Qujeq D, Kashifard M, Shokri-Shirvani J, Hajian-Tilaki K Acta Biomed. 2021; 91(4):e2020106.

PMID: 33525287 PMC: 7927538. DOI: 10.23750/abm.v91i4.8467.

References

Baron J, Connell A, KANAGHINIS T, Lennard-Jones J, Jones A . Out-patient treatment of ulcerative colitis. Comparison between three doses of oral prednisone. Br Med J. 1962; 2(5302):441-3. PMC: 1925835. DOI: 10.1136/bmj.2.5302.441. View

Neurath M, Travis S . Mucosal healing in inflammatory bowel diseases: a systematic review. Gut. 2012; 61(11):1619-35. DOI: 10.1136/gutjnl-2012-302830. View

Barreiro-de Acosta M, Vallejo N, de la Iglesia D, Uribarri L, Baston I, Ferreiro-Iglesias R . Evaluation of the Risk of Relapse in Ulcerative Colitis According to the Degree of Mucosal Healing (Mayo 0 vs 1): A Longitudinal Cohort Study. J Crohns Colitis. 2015; 10(1):13-9. DOI: 10.1093/ecco-jcc/jjv158. View

Wright R, Truelove S . Serial rectal biopsy in ulcerative colitis during the course of a controlled therapeutic trial of various diets. Am J Dig Dis. 1966; 11(11):847-57. DOI: 10.1007/BF02233941. View

Bessissow T, Lemmens B, Ferrante M, Bisschops R, Van Steen K, Geboes K . Prognostic value of serologic and histologic markers on clinical relapse in ulcerative colitis patients with mucosal healing. Am J Gastroenterol. 2012; 107(11):1684-92. DOI: 10.1038/ajg.2012.301. View

Yamamoto S, Nakase H, Mikami S, Inoue S, Yoshino T, Takeda Y . Long-term effect of tacrolimus therapy in patients with refractory ulcerative colitis. Aliment Pharmacol Ther. 2008; 28(5):589-97. DOI: 10.1111/j.1365-2036.2008.03764.x. View

Bryant R, Burger D, Delo J, Walsh A, Thomas S, von Herbay A . Beyond endoscopic mucosal healing in UC: histological remission better predicts corticosteroid use and hospitalisation over 6 years of follow-up. Gut. 2015; 65(3):408-14. DOI: 10.1136/gutjnl-2015-309598. View

Yokoyama K, Kobayashi K, Mukae M, Sada M, Koizumi W . Clinical Study of the Relation between Mucosal Healing and Long-Term Outcomes in Ulcerative Colitis. Gastroenterol Res Pract. 2013; 2013:192794. PMC: 3665176. DOI: 10.1155/2013/192794. View

TRUELOVE S, Witts L . Cortisone and corticotrophin in ulcerative colitis. Br Med J. 1959; 1(5119):387-94. PMC: 1992572. DOI: 10.1136/bmj.1.5119.387. View

10.

Hanauer S, Schwartz J, Robinson M, Roufail W, Arora S, Cello J . Mesalamine capsules for treatment of active ulcerative colitis: results of a controlled trial. Pentasa Study Group. Am J Gastroenterol. 1993; 88(8):1188-97. View

11.

Rutgeerts P, Sandborn W, Feagan B, Reinisch W, Olson A, Johanns J . Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2005; 353(23):2462-76. DOI: 10.1056/NEJMoa050516. View

12.

Mace V, Ahluwalia A, Coron E, Le Rhun M, Boureille A, Bossard C . Confocal laser endomicroscopy: a new gold standard for the assessment of mucosal healing in ulcerative colitis. J Gastroenterol Hepatol. 2015; 30 Suppl 1:85-92. DOI: 10.1111/jgh.12748. View

13.

DHaens G, Sandborn W, Feagan B, Geboes K, Hanauer S, Irvine E . A review of activity indices and efficacy end points for clinical trials of medical therapy in adults with ulcerative colitis. Gastroenterology. 2007; 132(2):763-86. DOI: 10.1053/j.gastro.2006.12.038. View

14.

Colombel J, Rutgeerts P, Reinisch W, Esser D, Wang Y, Lang Y . Early mucosal healing with infliximab is associated with improved long-term clinical outcomes in ulcerative colitis. Gastroenterology. 2011; 141(4):1194-201. DOI: 10.1053/j.gastro.2011.06.054. View

15.

Hoie O, Wolters F, Riis L, Aamodt G, Solberg C, Bernklev T . Ulcerative colitis: patient characteristics may predict 10-yr disease recurrence in a European-wide population-based cohort. Am J Gastroenterol. 2007; 102(8):1692-701. DOI: 10.1111/j.1572-0241.2007.01265.x. View

16.

Bitton A, Peppercorn M, Antonioli D, Niles J, Shah S, Bousvaros A . Clinical, biological, and histologic parameters as predictors of relapse in ulcerative colitis. Gastroenterology. 2001; 120(1):13-20. DOI: 10.1053/gast.2001.20912. View

17.

Hanauer S . Inflammatory bowel disease: epidemiology, pathogenesis, and therapeutic opportunities. Inflamm Bowel Dis. 2005; 12 Suppl 1:S3-9. DOI: 10.1097/01.mib.0000195385.19268.68. View

18.

Ikeya K, Sugimoto K, Kawasaki S, Iida T, Maruyama Y, Watanabe F . Tacrolimus for remission induction in ulcerative colitis: Mayo endoscopic subscore 0 and 1 predict long-term prognosis. Dig Liver Dis. 2015; 47(5):365-71. DOI: 10.1016/j.dld.2015.01.149. View

19.

Dignass A, Eliakim R, Magro F, Maaser C, Chowers Y, Geboes K . Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 1: definitions and diagnosis. J Crohns Colitis. 2012; 6(10):965-90. DOI: 10.1016/j.crohns.2012.09.003. View