Introduction Mucosal healing has shown to correlate with improved long term outcomes in patients with inflammatory bowel disease. Histological inflammation is often noted in endoscopically normal mucosa. We aimed to investigate the predictive role of endoscopic and histological inflammation on disease relapse in UC patients in clinical remission
Methods We conducted a retrospective review of adult patients in clinical remission who underwent surveillance colonoscopies in our institution from January 2008 to December 2011. Electronic records were reviewed for endoscopy reports and subsequent clinical care. Data was recorded on age, gender, duration and extent of the disease, medications, steroid use in the last 6 months, Mayo endoscopic score, Geboes histological activity index and follow up data for any flares till date. Patients were deemed to have a relapse if they required steroids or an increase in their medication dose fro symptom control in the subsequent 12 months following their index colonoscopy.
Statistical analysis: Rate of clinical relapse and the predictive value of the variables of interest were assessed using SPSS version 17. All variable analysed in univariate fashion and included in multivariate analysis if p was less than ≤0.3. Multivariate analysis was based on an automated backward logistic selection process. P values < 0.05 were considered significant.
Results 406 patients underwent surveillance colonoscopy during the study period of which 317 (Male: 172 Females: 145) met the inclusion criteria. 57 patients (Males 29, females 28) relapsed within 12 months (Table 1 provides the baseline characteristics). On univariate analysis age (OR 0.96 95%CI 0.94–0.98), Geboes score ≥2 (4.53, 2.40–8.52) and Mayo score ≥1 (3.72, 2.05–6.73) were significantly associated with relapse. Duration of disease (p = 0.09), use of immunomodulators (p = 0.29) and recent steroid use (p = 0.3) were included in the multivariate analysis. On multivariate analysis Geboes score of ≥2 (5.11, 2.73–9.59) and age (0.97, 0.97–0.99) were predictive of clinical relapse.
Conclusion Histological activity and younger age are significant predictors of disease relapse in patients undergoing surveillance endoscopy. Endoscopic activity with standard white light endoscopy did not predict clinical relapse. Better non-invasive markers of disease relapse are required for patients with ulcerative colitis
Disclosure of Interest None Declared.
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