BACKGROUND: Patients with ulcerative colitis (UC) who are in clinical remission may still have underlying endoscopic inflammation, which is associated with inferior clinical outcomes. The goal of this study was to determine the prevalence of active endoscopic disease, and factors associated with it, in patients with UC who are in clinical remission. METHODS: Prospective observational study in a single center. Patients with UC in clinical remission (by Simple Clinical Colitis Activity Index) were enrolled prospectively at the time of surveillance colonoscopy. Disease phenotype, endoscopic activity (Mayo subscore), and histologic score (Geboes) were recorded, and blood was drawn for peripheral blood biomarkers. RESULTS: Overall, 149 patients in clinical remission were prospectively enrolled in this cohort; 81% had been in clinical remission for >6 months, and 86% were currently prescribed maintenance medications. At endoscopy, 45% of patients in clinical remission had any endoscopic inflammation (Mayo endoscopy subscore >0), and 13% had scores >1. In a multivariate model, variables independently associated with a Mayo endoscopic score >1 were remission for <6 months (P = 0.001), white blood count (P = 0.01), and C-reactive protein level (P = 0.009). A model combining these 3 variables had a sensitivity of 94% and a specificity of 73% for predicting moderate-to-severe endoscopic activity in patients in clinical remission (area under the curve, 0.86). In an unselected subgroup of patients who had peripheral blood mononuclear cell messenger RNA profiling, GATA3 messenger RNA levels were significantly higher in patients with endoscopic activity. CONCLUSIONS: Duration of clinical remission, white blood count, and C-reactive protein level can predict the probability of ongoing endoscopic activity, despite clinical remission in patients with UC. These parameters could be used to identify patients who require intensification of treatment to achieve mucosal healing.
BACKGROUND:Patients with ulcerative colitis (UC) who are in clinical remission may still have underlying endoscopic inflammation, which is associated with inferior clinical outcomes. The goal of this study was to determine the prevalence of active endoscopic disease, and factors associated with it, in patients with UC who are in clinical remission. METHODS: Prospective observational study in a single center. Patients with UC in clinical remission (by Simple Clinical Colitis Activity Index) were enrolled prospectively at the time of surveillance colonoscopy. Disease phenotype, endoscopic activity (Mayo subscore), and histologic score (Geboes) were recorded, and blood was drawn for peripheral blood biomarkers. RESULTS: Overall, 149 patients in clinical remission were prospectively enrolled in this cohort; 81% had been in clinical remission for >6 months, and 86% were currently prescribed maintenance medications. At endoscopy, 45% of patients in clinical remission had any endoscopic inflammation (Mayo endoscopy subscore >0), and 13% had scores >1. In a multivariate model, variables independently associated with a Mayo endoscopic score >1 were remission for <6 months (P = 0.001), white blood count (P = 0.01), and C-reactive protein level (P = 0.009). A model combining these 3 variables had a sensitivity of 94% and a specificity of 73% for predicting moderate-to-severe endoscopic activity in patients in clinical remission (area under the curve, 0.86). In an unselected subgroup of patients who had peripheral blood mononuclear cell messenger RNA profiling, GATA3 messenger RNA levels were significantly higher in patients with endoscopic activity. CONCLUSIONS: Duration of clinical remission, white blood count, and C-reactive protein level can predict the probability of ongoing endoscopic activity, despite clinical remission in patients with UC. These parameters could be used to identify patients who require intensification of treatment to achieve mucosal healing.
Authors: Marc Ferrante; Séverine Vermeire; Herma Fidder; Fabian Schnitzler; Maja Noman; Gert Van Assche; Gert De Hertogh; Ilse Hoffman; Andre D'Hoore; Kristel Van Steen; Karel Geboes; Freddy Penninckx; Paul Rutgeerts Journal: J Crohns Colitis Date: 2008-05-16 Impact factor: 9.071
Authors: Manuel Luis Rodríguez-Perálvarez; Valle García-Sánchez; Carlos Manuel Villar-Pastor; Raál González; Eva Iglesias-Flores; Jordi Muntane; Federico Gómez-Camacho Journal: Inflamm Bowel Dis Date: 2012-01-11 Impact factor: 5.325
Authors: Michael D Kappelman; Sheryl L Rifas-Shiman; Carol Q Porter; Daniel A Ollendorf; Robert S Sandler; Joseph A Galanko; Jonathan A Finkelstein Journal: Gastroenterology Date: 2008-09-17 Impact factor: 22.682
Authors: Boyko Kabakchiev; Dan Turner; Jeffrey Hyams; David Mack; Neal Leleiko; Wallace Crandall; James Markowitz; Anthony R Otley; Wei Xu; Pingzhao Hu; Anne M Griffiths; Mark S Silverberg Journal: PLoS One Date: 2010-09-30 Impact factor: 3.240
Authors: Matthew Rutter; Brian Saunders; Kay Wilkinson; Steve Rumbles; Gillian Schofield; Michael Kamm; Christopher Williams; Ashley Price; Ian Talbot; Alastair Forbes Journal: Gastroenterology Date: 2004-02 Impact factor: 22.682
Authors: Noa Krugliak Cleveland; David T Rubin; John Hart; Christopher R Weber; Katherine Meckel; Anthony L Tran; Arthur S Aelvoet; Isabella Pan; Alex Gonsalves; John Nick Gaetano; Kelli M Williams; Kristen Wroblewski; Bana Jabri; Joel Pekow Journal: Clin Gastroenterol Hepatol Date: 2017-07-26 Impact factor: 11.382
Authors: Talia Zenlea; Eric U Yee; Laura Rosenberg; Marie Boyle; Kavinderjit S Nanda; Jacqueline L Wolf; Kenneth R Falchuk; Adam S Cheifetz; Jeffrey D Goldsmith; Alan C Moss Journal: Am J Gastroenterol Date: 2016-03-15 Impact factor: 10.864
Authors: Laura Rosenberg; Kavinderjit S Nanda; Talia Zenlea; Anne Gifford; Garrett O Lawlor; Kenneth R Falchuk; Jacqueline L Wolf; Adam S Cheifetz; Jeffrey D Goldsmith; Alan C Moss Journal: Clin Gastroenterol Hepatol Date: 2013-04-13 Impact factor: 11.382