David Laharie1, Arnaud Bourreille2, Julien Branche3, Matthieu Allez4, Yoram Bouhnik5, Jerome Filippi6, Frank Zerbib7, Guillaume Savoye8, Lucine Vuitton9, Jacques Moreau10, Aurelien Amiot11, Laurent Beaugerie12, Elena Ricart13, Olivier Dewit14, Antonio Lopez-Sanroman15, Mathurin Fumery16, Franck Carbonnel17, Anthony Buisson18, Benoit Coffin19, Xavier Roblin20, Gert van Assche21, Maria Esteve22, Martti Farkkila23, Javier P Gisbert24, Philippe Marteau25, Stephane Nahon26, Martine de Vos27, Laurent Peyrin-Biroulet28, Jean-Yves Mary29. 1. INSERM CIC 1401, Service d'hépato-gastroentérologie et oncologie digestive, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, CHU de Bordeaux, Université de Bordeaux, Bordeaux, France. Electronic address: david.laharie@chu-bordeaux.fr. 2. Institut des Maladies de l'Appareil Digestif, Hépato-Gastroentérologie, Hôtel-Dieu, CHU de Nantes, Nantes, France. 3. Service des maladies de l'appareil digestif-Endoscopie digestive, Hôpital Claude Huriez, CHRU de Lille, Lille, France. 4. Service d'Hépato-Gastroentérologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Paris, France. 5. Gastroentérologie, MICI et Assistance Nutritive, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Clichy, France. 6. Service de Gastroentérologie et Nutrition Clinique, Hôpital de l'Archet 2, CHU de Nice, Nice, France. 7. INSERM CIC 1401, Service d'hépato-gastroentérologie et oncologie digestive, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, CHU de Bordeaux, Université de Bordeaux, Bordeaux, France. 8. UMR 1073, Service de Gastroentérologie, Hôpital Charles Nicolle, CHU de Rouen, Normandie Université-Rouen, Rouen, France. 9. Service de Gastroentérologie, Hôpital Jean Minjoz, CHU de Besançon, Besançon, France. 10. Service de Gastro-entérologie et Nutrition, Hôpital Rangueil, CHU de Toulouse, Toulouse, France. 11. Service d'Hépato-gastroentérologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Créteil, Créteil, France. 12. Department of Gastroenterology, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France. 13. Gastroenterology Department, Hospital Clínic, Augus Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain. 14. Service d'Hépato-Gastroentérologie, UCL Saint Luc, Brussels, Belgium. 15. Unidad de EII / IBD Unit, Servicio de Gastroenterología y Hepatología, Hospital Ramón y Cajal, Madrid, Spain. 16. Peritox UMR I-01, Service d'Hépato-Gastroentérologie, CHU Amiens, Amiens, France. 17. Service d'Hépato-Gastroentérologie, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Université Paris Sud 11, Le Kremlin-Bicêtre, France. 18. INSERM U1071, M2iSH, USC-INRA 2018, 3iHP, Service d'Hépato-Gastroentérologie, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France. 19. Pôle Maladie Appareil Digestif, Service d'Hépato-Gastroentérologie, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Colombes, France. 20. Service de Gastro-entérologie et Hépatologie, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne, France. 21. Division of Gastroenterology and Hepatology, University Hospital Leuven, Leuven, Belgium. 22. Department of Gastroenterology, Hospital Universitari Mútua de Terrassa, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Terrassa, Spain. 23. Clinic of Gastroenterology, Helsinki University Central Hospital, Helsinki University, Helsinki, Finland. 24. Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain. 25. Service Hépato-gastroentérologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris Sorbonne Université, Paris, France. 26. Service d'Hépato-gastroentérologie, CHI Le Raincy Montfermeil, Montfermeil, France. 27. Gastroenterology unit, Ghent University Hospital, Gent, Belgium. 28. INSERM U1256 NGERE, Department of Hepato-Gastroenterology, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France. 29. INSERM UMR-S-1153, Equipe ECSTRA, Hôpital Saint-Louis, Paris Diderot University, Paris, France.
Abstract
BACKGROUND/AIMS: Few data on the evolution of endoscopic findings are available in patients with acute severe ulcerative colitis (ASUC). The aim of this study was to describe this evolution in a prospective cohort. METHODS: Patients admitted for a steroid-refractory ASUC and included in a randomized trial comparing infliximab and cyclosporine were eligible if they achieved steroid-free clinical remission at day 98. Flexible sigmoidoscopies were performed at baseline, days 7, 42 and 98. Ulcerative colitis endoscopic index of severity (UCEIS) and its sub-scores - vascular pattern, bleeding and ulceration/erosion - were post-hoc calculated. Global endoscopic remission was defined by a UCEIS of 0, and partial endoscopic remission by any UCEIS sub-score of 0. RESULTS: Among the 55 patients analyzed (29 infliximab and 26 cyclosporine), 49 (83%) had UCEIS ≥6 at baseline at baseline. Partial endoscopic remission rates were higher for bleeding than for vascular pattern and for ulcerations/erosions at day 7 (20% vs. 4% and 5% (n = 55); p = .004 and p=.04), for bleeding and ulceration/erosion than for vascular pattern at day 42 [63% and 65% vs. 33% (n=54); p<.001 for both] and at day 98 [78% and 92% vs. 56% (n = 50); p = .007 and p < .001]. Global endoscopic remission rates at day 98 were higher in patients treated with infliximab than with cyclosporine [73% vs. 25% (n = 26 and 24); p < .001]. CONCLUSION: In steroid-refractory ASUC patients responding to a second-line medical therapy, endoscopic remission process started with bleeding remission and was not achieved in half the patients at day 98 for vascular pattern. Infliximab provided a higher endoscopic remission rate than cyclosporine at day 98.
BACKGROUND/AIMS: Few data on the evolution of endoscopic findings are available in patients with acute severe ulcerative colitis (ASUC). The aim of this study was to describe this evolution in a prospective cohort. METHODS:Patients admitted for a steroid-refractory ASUC and included in a randomized trial comparing infliximab and cyclosporine were eligible if they achieved steroid-free clinical remission at day 98. Flexible sigmoidoscopies were performed at baseline, days 7, 42 and 98. Ulcerative colitis endoscopic index of severity (UCEIS) and its sub-scores - vascular pattern, bleeding and ulceration/erosion - were post-hoc calculated. Global endoscopic remission was defined by a UCEIS of 0, and partial endoscopic remission by any UCEIS sub-score of 0. RESULTS: Among the 55 patients analyzed (29 infliximab and 26 cyclosporine), 49 (83%) had UCEIS ≥6 at baseline at baseline. Partial endoscopic remission rates were higher for bleeding than for vascular pattern and for ulcerations/erosions at day 7 (20% vs. 4% and 5% (n = 55); p = .004 and p=.04), for bleeding and ulceration/erosion than for vascular pattern at day 42 [63% and 65% vs. 33% (n=54); p<.001 for both] and at day 98 [78% and 92% vs. 56% (n = 50); p = .007 and p < .001]. Global endoscopic remission rates at day 98 were higher in patients treated with infliximab than with cyclosporine [73% vs. 25% (n = 26 and 24); p < .001]. CONCLUSION: In steroid-refractory ASUC patients responding to a second-line medical therapy, endoscopic remission process started with bleeding remission and was not achieved in half the patients at day 98 for vascular pattern. Infliximab provided a higher endoscopic remission rate than cyclosporine at day 98.