Pit patterns in rectal mucosa assessed by magnifying colonoscopy are predictive of relapse in patients with quiescent ulcerative colitis

Yuji Nishio ¹, Takafumi Ando ^1*, Osamu Maeda ¹, Kazuhiro Ishiguro ¹, Osamu Watanabe ¹, Naoki Ohmiya ¹, Yasumasa Niwa ¹, Kazuo Kusugami ² and Hidemi Goto ¹

¹ Department of Gastroenterology, Nagoya University Graduate School of Medicine, Japan
² Department of Food Science and Nutrition, Nagoya Women's University, Japan

^* To whom correspondence should be addressed. E-mail: takafumia-gi{at}umin.ac.jp.

Accepted 5 April 2006

Abstract

Background: Relapse of ulcerative colitis (UC) is difficult to predict by routine colonoscopy. A high- resolution video-magnifying colonoscope with chromoscopy enables the observation of colorectal mucosal pit patterns.

Aims: We investigated the association between pit patterns as assessed by magnifying colonoscopy with histological inflammation and mucosal chemokine activity in patients with quiescent UC, and prospectively analyzed prognostic factors that may predict exacerbations.

Methods: Magnifying colonoscopy was performed in 113 UC patients in remission. Pit patterns in the rectal mucosa were classified into four magnifying-colonoscopy (MCS) grades on the basis of size, shape, and arrangement. Mucosal interleukin (IL)-8 activity in biopsy specimens of rectal mucosa was measured and the specimens were assessed histological disease activity. The patients were then followed until relapse or a maximum of 12 months. Multivariate survival analysis was performed to determine independent predictors of clinical relapse.

Results: A positive correlation was identified between MCS grade, histological grade (p=0.0001), and mucosal IL-8 activity (p<0.0001). Multivariate proportional hazard model analysis showed that MCS grade was a significant predictor of relapse (relative risk: 2.06, p=0.0009). Kaplan-Meier estimate of relapse during 12 months follow-up was found to increase with increasing MCS grade, with percentages of 0% for grade 1, 21% for grade 2, 43% for grade 3, and 60% for grade 4.

Conclusion: MCS grading is associated with the degree of histological inflammation and mucosal IL-8 activity in quiescent UC patients, and may predict the probability of subsequent disease relapse in UC patients in remission.

Keywords: high-resolution video-magnifying colonoscope with chromoscopy, prediction of relapse, ulcerative colitis

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Digest

Robin Spiller and Alastair Watson
Gut 2006 55: 1685. [Extract] [Full Text] [PDF]