scholarly journals P561 Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and Mayo Endoscopic Score (MES) in predicting the therapeutic effect of mesalazine in UC patients

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S524-S525
Author(s):  
L Wu ◽  
Y Zhang ◽  
Q Cao
Keyword(s):  
Ulcerative Colitis ◽  
High Probability ◽  
Primary Outcome ◽  
Demographic Data ◽  
Clinical Observations ◽  
Previous Therapy ◽  
Endoscopic Score ◽  
Index Of Severity ◽  
Roc Area

Abstract Background The Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and the Mayo Endoscopic Score (MES) were developed as an objective method of the endoscopic severity in ulcerative colitis (UC); however, it was still unclear whether UCEIS and MES could guide the mesalazine treatment in UC. Methods Consecutive UC patients who had undergone colonoscopy within 1 month before starting mesalazine between October 2011 and July 2016 were retrospectively evaluated. Demographic data, previous therapy, clinical observations, laboratory parameters, medical therapy and endoscopic assessments were documented. The primary outcome was the need for ‘step up’ treatment (containing the use of corticosteroids, immunomodulatory or surgery.) during admission and follow-up. Results Sixty-five patients were enrolled, 12(18.5%) needed ‘step up’ treatment’ due to primary or secondary nonresponse to mesalazine. UCEIS score is a predictor of primary or secondary nonresponse to mesalazine in multivariate analysis (OR, 25.65; 95% CI, 3.048–45.985; P =0.003). Receiver-operator characteristic (ROC) area of UCEIS is 0.95, with a sensitivity of 100% and specificity of 84.6%, using cut-off value of 6, which outperforms MES with the ROC area of 0.70; When UCEIS score ≥6, 60% of patients eventually need ‘step up’ treatment. Conclusion UCEIS score is a useful instrument for evaluating endoscopic improvement in UC patients treated with mesalazine. The high probability of mesalazine treatment failure and benefits of other therapy should be discussed in patients with baseline UCEIS ≥ 6.

scholarly journals P545 Calprotectin at week 12 is a predictor for histological remission in ulcerative colitis patients treated with Vedolizumab

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S515-S516
Author(s):  
D Rubstov ◽  
P Kakkadasam Ramaswamy ◽  
J Edwards ◽  
D Shukla ◽  
L Willmann ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Remission ◽  
Real World Setting ◽  
Endoscopic Remission ◽  
Endoscopic Score ◽  
Histological Activity ◽  
Maintenance Of Remission ◽  
Histological Remission ◽  
Endoscopic Assessment

Abstract Background Vedolizumab (VDZ) is a gut-specific α4β7 integrin antagonist that has demonstrated efficacy for induction and maintenance of remission in moderate to severe ulcerative colitis (UC). The aim of this study was to assess the rates of histological remission (HR) in a real-world setting and to identify predictors for histological remission. Methods Retrospective cohort study of all UC patients (≥18 years) initiated on VDZ from 2016 to 2020 was completed. Clinical, biochemical, endoscopic and histologic data were collected. All patients received standard induction therapy with VDZ 300 mg IV at Weeks 0, 2, and 6 and maintained on an 8-weekly regimen. Dose was escalated to a every 4-weekly regimen as per physician’s discretion. A 52-week follow-up was completed on all patients. Endoscopic assessment was carried out between 24 and 52 weeks after commencing VDZ. Histological activity was graded as per Nancy index and histological remission was defined as Nancy grade 0. Endoscopic remission was defined as Mayo endoscopic score = 0. Clinical remission was defined as SCCAI ≤ 5. Results A total of 51 patients [55% female, median age 48 years (IQR 35–60)] were included. 16/51 (34%) were anti-TNF exposed. In 30/51 (59%) patients VDZ was combined with steroids at induction and by week 12 steroids were completely tapered in 14/30 (46.7%) patients. At weeks 12, 24 and 52, 89.6%, 87% and 97.5% of patients, respectively, were in clinical remission. 19/37 (51.3%) patients were in endoscopic remission at end of follow up. Median Nancy score prior to commencing VDZ was 3 (IQR: 2–4) and the median Nancy score at end of follow up was 1 (IQR: 0–2). 19/37 (51.3%) patients achieved HR; 3 patients who were in HR at the time of commencement of VDZ remained in HR at the end of follow up. Median baseline faeces calprotectin (FC) was 320 mcg/g (IQR 45–1000) and was similar in patients who achieved HR and those who did not. Median FC at 12 weeks was 155 mcg/g (45–720) and was significantly lower in patients who achieved HR when compared to patients who did not achieve histological remission (45 vs 420, p 0.028). FC at week 12 predicted histological remission (AUC =0.8667). FC ≥ 200mcg/g at week 12 predicted failure to achieve HR with sensitivity 70%, specificity 100%, PPV 100%, NPV 75%, accuracy 84%. Conclusion Vedolizumab is effective in achieving histological remission and FC ≥ 200 mcg/g at week 12 accurately predicts failure to achieve HR in patients treated with VDZ.

scholarly journals P162 Microscopic inflammation in limited Ulcerative Colitis at diagnosis: can a single histological feature predict prognosis?

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S240-S240
Author(s):  
J Revés ◽  
C Frias Gomes ◽  
P Ellul ◽  
C Callé ◽  
A Almeida ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Infiltrate ◽  
Primary Outcome ◽  
Univariate Analysis ◽  
Single Component ◽  
Clinical Severity ◽  
Histological Feature ◽  
Cox Regression Analysis ◽  
Histological Features

Abstract Background Histological assessment is becoming increasingly important in the management of Ulcerative Colitis (UC). The Nancy index (NI), a recently developed and validated score, has been shown to accurately represent histological inflammation and to correlate with prognosis. However, it is a composite score, involving the analysis of more than one histological feature, which may limit its applicability. Our aim was to evaluate if a single component of the NI could individually predict prognosis in limited UC (E1 and E2) patients. Methods Multi-centre retrospective cohort study of newly diagnosed, treatment-naïve proctitis and left-sided ulcerative colitis patients. Biopsies from inflamed rectal mucosa were reviewed by two pathologists. Histological features from the NI were selected for analysis, including presence of ulcers, acute inflammatory infiltrate (with separate evaluation of neutrophils in lamina propria and epithelium) and chronic inflammatory infiltrate. Mucin depletion and basal plasmacytosis were also evaluated. The primary outcome was a composite outcome intended to evaluate disease-related complications, including proximal disease extension, need for hospitalisation or colectomy. Survival analysis, including univariate and multivariate Cox-regression analysis was performed. Results A total of 91 patients were included (56.0% males, mean age 44±17 years, median follow-up 44 months [2–328]). Overall, 64.8% of the patients had proctitis (E1) and 35.2% left-sided colitis (E2). The most frequent histological features were the presence of chronic inflammatory infiltrate (93.4%), mucin depletion (81.3%) and basal plasmacytosis (78.0%). During the follow-up, 22.0% presented a disease-related complication. The NI was not able to predict prognosis (HR 3.09, 95% CI 0.71–13.36, p=0.132). In univariate analysis, the presence of neutrophils in the epithelium in more than 50% of the crypts was marginally significant for the primary outcome (HR 2.51, 95% CI 0.99–6.36, p=0.05). In multivariate analysis, after adjusting for gender, age at diagnosis, disease extent (E1 vs E2), Mayo endoscopic score (< 2 vs ≥ 2) and clinical severity at diagnosis (mild vs moderate to severe UC) this single component of the score was associated with the primary outcome (aHR 3.36, 95% IC 1.21–9.31, p=0.02). No other histological feature was able to individually predict prognosis (p>0.05). Conclusion The presence of neutrophils in the epithelium in more than 50% of the crypts in endoscopically inflamed mucosa at diagnosis was associated with higher disease complications in limited UC patients. The evaluation of a single feature could facilitate the use of histology in the prediction of prognosis in UC. Our results need to be prospectively validated.

scholarly journals Clinical Characterization of Ulcerative Colitis in Patients with Primary Sclerosing Cholangitis

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Shun Murasugi ◽  
Ayumi Ito ◽  
Teppei Omori ◽  
Shinichi Nakamura ◽  
Katsutoshi Tokushige
Keyword(s):  
Ulcerative Colitis ◽  
Primary Sclerosing Cholangitis ◽  
Sclerosing Cholangitis ◽  
Prognostic Impact ◽  
Asymptomatic Patients ◽  
Younger Age ◽  
Endoscopic Score ◽  
Index Of Severity ◽  
Backwash Ileitis ◽  
The Right

Objectives. The clinical/colonoscopic features of ulcerative colitis (UC) associated with primary sclerosing cholangitis (PSC), the prognostic impact of UC, and the utility of UC screening in PSC patients are unknown. We characterized UC associated with PSC and assessed UC’s impact on the prognosis of PSC and the importance of colonoscopic UC screening in PSC patients. Methods. We retrospectively analyzed the cases of 77 patients treated for PSC at a single center (April 2000–July 2019). We reviewed the clinical/colonoscopic profiles of the concurrent UC patients and compared the clinical profiles, survival, and primary causes of death between the patients with/without UC ( n = 35 / n = 42 ). The details of all patients’ colonoscopies were reviewed. Results. The concurrent UC group: 17 men, 18 women, diagnosed with PSC at the mean (SD) age of 36 (17) years; 21 patients (60%) had no UC symptoms. Colonoscopy revealed pancolitis in all patients, predominantly affecting the right-sided colon in 30 patients (86%). Lesions were scattered. Backwash ileitis ( n = 13 , 37%) and rectal sparing ( n = 18 , 51%) were observed. Most patients had mild UC; some had moderate or more severe UC (median Ulcerative Colitis Endoscopic Index of Severity (UCEIS) score 2; range, 1–5). Ludwig’s stage determined by liver biopsy did not correlate with the Mayo endoscopic score for UC. The patients with UC were diagnosed with PSC at a significantly younger age than those without UC (mean (SD), 36 [17] years vs. 55 [19] years, p < 0.0001 ) and had a significantly higher 5-year survival rate (97.1% vs. 70.5%, p = 0.0028 ). UC was detected in 19 of 34 asymptomatic patients (56%) who underwent colonoscopy screening. Conclusions. Our cohort’s clinical/colonoscopic features of UC associated with PSC are more moderate or severe UC than previous cases. The coexistence of UC might affect the prognosis of PSC. In this regard, colonoscopy in PSC patients is an important examination for determining prognosis. There is also asymptomatic UC in patients with PSC. In this regard, screening for colonoscopy in PSC patients is essential. When a diagnosis of PSC is made, immediate colonoscopy is a priority with UC complications in mind.

scholarly journals The Ulcerative Colitis Endoscopic Index of Severity More Accurately Reflects Clinical Outcomes and Long-term Prognosis than the Mayo Endoscopic Score

2015 ◽  
Vol 10 (3) ◽  
pp. 286-295 ◽  
Author(s):  
Kentaro Ikeya ◽  
Hiroyuki Hanai ◽  
Ken Sugimoto ◽  
Satoshi Osawa ◽  
Shinsuke Kawasaki ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Outcomes ◽  
Endoscopic Score ◽  
Index Of Severity ◽  
Long Term Prognosis

scholarly journals Preoperative Endoscopic Activity Predicts the Occurrence of Pouchitis After Ileal Pouch–Anal Anastomosis in Ulcerative Colitis: A Multicenter Retrospective Study in China

2021 ◽  
Vol 8 ◽  
Author(s):  
Weimin Xu ◽  
Wenbo Tang ◽  
Wenjun Ding ◽  
Hang Hu ◽  
Wenhao Chen ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Ileal Pouch ◽  
Activity Index ◽  
Disease Activity Index ◽  
Ileal Pouch Anal Anastomosis ◽  
Colonoscopic Surveillance ◽  
Anal Anastomosis ◽  
Index Of Severity ◽  
Roc Area ◽  
Pouchitis Disease Activity Index

Background: Pouchitis is the most common long-term complication after ileal pouch–anal anastomosis (IPAA) in patients with ulcerative colitis (UC). Ulcerative colitis endoscopic index of severity (UCEIS) and Mayo endoscopic score (MES) are widely used indices to evaluate endoscopic activity. This study aimed to clarify the predictive value of preoperative endoscopic activity on the occurrence of pouchitis after IPAA.Methods: Data of patients with UC who underwent IPAA from January 2008 to January 2020 were collected retrospectively. UCEIS and MES were based on the preoperative colonoscopy findings of two independent endoscopists.Results: A total of 102 patients with a median follow-up of 5 (interquartile range, 2–9) years were included in the study. Among them, 21.6% developed pouchitis. Compared with MES, UCEIS had a stronger correlation with pouchitis disease activity index. UCEIS ≥ 7 had the most significant receiver-operating characteristic (ROC) curve area of 0.747 with a sensitivity of 68.2% and specificity of 81.2% in predicting pouchitis, which outperformed MES of 3 with an ROC area of 0.679 with a sensitivity of 54.5% and specificity of 81.2%. Furthermore, we found that UCEIS ≥ 7 was an independent risk factor for post-IPAA pouchitis [odds ratio (OR), 8.860; 95% CI, 1.969–39.865, p &lt; 0.001] with a higher risk than MES of 3 (OR, 5.200; 95% CI, 1.895–14.273; p = 0.001).Conclusion: Ulcerative colitis endoscopic index of severity performed better in predicting pouchitis after IPAA than MES. Earlier and more frequent postoperative colonoscopic surveillance should be considered in patients with preoperative UCEIS ≥ 7 to detect the occurrence of pouchitis earlier.

scholarly journals Efficacy of Sigmoidoscopy for Evaluating Disease Activity in Patients With Ulcerative Colitis

2021 ◽  
Author(s):  
Su Bum Park ◽  
Seong-Jung Kim ◽  
Jun Lee ◽  
Yoo Jin Lee ◽  
Dong Hoon Baek ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Disease Activity ◽  
Proximal Colon ◽  
Concordance Rate ◽  
Tertiary Hospitals ◽  
High Concordance ◽  
Endoscopic Score ◽  
Index Of Severity ◽  
Endoscopic Assessment ◽  
Key Parameter

Abstract Background: Endoscopic assessment of disease activity is a key parameter in the management of ulcerative colitis. Whether sigmoidoscopy alone is sufficient to evaluate the disease activity in ulcerative colitis lacks studies. Methods: We retrospectively analyzed the medical records and endoscopic results of patients with ulcerative colitis followed by colonoscopy in seven tertiary hospitals between January 2012 and December 2018. Endoscopic disease activity was scored using the Mayo Endoscopic Score (MES) and Ulcerative Colitis Endoscopic Index of Severity (UCEIS) for each segment from the colonoscopy images. Concordance was evaluated by comparing the highest MES and UCEIS in the rectosigmoid and proximal regions to confirm the usefulness of sigmoidoscopy. Results: A total of 500 colonoscopic examinations from 333 patients were enrolled. Only in 7.6% [k(kappa): 0.893, r(Spearman): 0.906, p<0.001] and 8.6% [k(kappa): 0.890, r(Spearman): 0.914; p<0.001] of cases, MES and UCEIS scored more severely in the proximal colon. Comparison of active disease (MES ≥2) in the rectosigmoid area and the entire colon showed a high concordance rate [k(kappa): 0.899, r(Spearman): 0.904, p<0.001]. Endoscopic healing (MES=0) also showed a high concordance rate [k(kappa): 0.882, r(Spearman): 0.887, p<0.001]. In 38 cases (7.6%) of patients with a higher MES in the proximal area, it was significantly higher in patients with previous extensive colitisConclusions: Sigmoidoscopy and colonoscopy showed a high concordance rate. Therefore, sigmoidoscopy is considered a sufficient substitute for colonoscopy. However, colonoscopy should be considered in patients with previous extensive colitis

scholarly journals Role of Fecal Calprotectin as a Noninvasive Indicator for Ulcerative Colitis Disease Activity

Folia Medica ◽  
2019 ◽  
Vol 61 (2) ◽  
pp. 188-196 ◽  
Author(s):  
Radislav V. Nakov ◽  
Ventsislav N. Nakov ◽  
Vanya A. Gerova ◽  
Lyudmila T. Tankova
Keyword(s):  
Ulcerative Colitis ◽  
Disease Activity ◽  
Intestinal Inflammation ◽  
Point Of Care ◽  
Fecal Calprotectin ◽  
Non Invasive ◽  
Significant Difference ◽  
Endoscopic Score ◽  
Index Of Severity

Abstract Background: It is essential in clinical management to determine the disease activity in ulcerative colitis (UC) patients. At present, the most accurate way of evaluating the UC severity is endoscopy with biopsy. Fecal calprotectin (FCP) is a non-invasive biomarker that is frequently used for monitoring of intestinal inflammation. Aims: The purpose of our study was to assess the role of FCP as a noninvasive indicator for UC disease activity. Materials and methods: This prospective study enrolled 116 patients with UC (56 with quiescent UC and 60 with active UC) and 36 controls, referred for colonoscopy to our Center. Colonoscopy was performed in all the patients and the findings were graded according to Mayo endoscopic score (EMS) and UC endoscopic index of severity (UCEIS). FCP was analyzed in stool samples by means of point-of-care desk-top Quantum Blue® method. Results: There was no significant difference between mean FCP levels in controls and UC patients in remission (р=0.205). Mean FCP in patients with active UC was significantly higher than that in controls (p<0.001) and in patients in remission (p<0.001). FCP significantly correlated with UCEIS (r = 0.869, p<0.001) and EMS (r = 0.814, p<0.001). Conclusion: The strong correlation with endoscopic disease activity suggests that FCP is a useful biomarker for noninvasive diagnosis and monitoring of disease activity in UC patients.

scholarly journals Inter-Observer Agreement of a New Endoscopic Score for Ulcerative Colitis Activity: Preliminary Experience

Diagnostics ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. 213
Author(s):  
Mariabeatrice Principi ◽  
Antonella Contaldo ◽  
Francesco Paolo Bianchi ◽  
Giuseppe Losurdo ◽  
Andrea Iannone ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Scoring Systems ◽  
Mucosal Damage ◽  
Observer Agreement ◽  
P Value ◽  
Rater Agreement ◽  
Colon Segment ◽  
Endoscopic Score ◽  
Web Platform

Ulcerative colitis (UC) endoscopic scores translate mucosal damage into values standardizing image analysis. Due to potential limits of current endoscopic activity indexes, we have elaborated on a new score, the “Extended Mayo Endoscopic Score (EMES),” and evaluated its inter-observer agreement in a multicenter endoscopy team, comparing concordance with the Mayo subscore. Sixteen UC consecutive patients underwent follow-up colonoscopy. Recorded videos were anonymously loaded on a web platform. Thirteen expert endoscopists evaluated UC activity using both Mayo and EMES. EMES was described in every colon segment: erythema (0: absent, 1: mild, 2: moderate, 3: severe), vascular pattern (0: normal, 1: reduction, 2: disappearance), erosions and ulcers (0: absent, 1: from 1 to 5, 2: 6 to 10, 3: >10). Weighted Fleiss’ kappa with 95% confidence interval (CI) and p-value defined inter-rater agreement. Global inter-observer agreement of EMES was moderate (kappa = 0.56, 95% CI = 0.46–0.67, p < 0.001). The evaluation of each colonic segment showed moderate agreement for all segments: ascending (kappa = 0.46, 95% CI = 0.32–0.60, p < 0.001), transverse (kappa = 0.48, 95% CI = 0.29–0.67, p < 0.001); descending (kappa = 0.49, 95% CI = 0.35–0.64, p < 0.001), sigmoid (kappa = 0.52, 95% CI = 0.39–0.65, p < 0.001) and rectum (kappa = 0.55, 95% CI = 0.42–0.69, p < 0.001). Mayo subscore agreement was similar to global EMES (kappa = 0.53, 95% CI = 0.39–0.66, p = 0.001). Therefore, our report emphasizes the importance of assessing inter-observer agreement for EMES, but also for other known scoring systems, including the Mayo subscore.

scholarly journals ADALIMUMAB FOR ULCERATIVE COLITIS: RESULTS OF A BRAZILIAN MULTICENTER OBSERVATIONAL STUDY

2017 ◽  
Vol 54 (4) ◽  
pp. 321-327 ◽  
Author(s):  
Patrícia ZACHARIAS ◽  
Aderson Omar Mourão Cintra DAMIÃO ◽  
Antonio Carlos MORAES ◽  
Fábio Vieira TEIXEIRA ◽  
Juliano Coelho LUDVIG ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Latin American ◽  
Clinical Remission ◽  
Demographic Data ◽  
Case Series ◽  
Severe Ulcerative Colitis ◽  
Mayo Score ◽  
Adalimumab Therapy ◽  
Remission Rates

ABSTRACT BACKGROUND: Adalimumab is a monoclonal antibody, tumor necrosis factor-alpha (TNFα) inhibitor that has efficacy for inducing and maintaining remission in moderate-to-severe ulcerative colitis. Real world studies with adalimumab in Latin American ulcerative colitis patients are scarce. OBJECTIVE: To assess the clinical remission rates in induction and maintenance with adalimumab therapy in ulcerative colitis. METHODS: Observational, multicenter and retrospective study on a case series of patients with moderate-to-severe ulcerative colitis under adalimumab therapy. The variables analyzed were: demographic data, previous infliximab status, concomitant drugs, the Montreal Classification, disease activity (Mayo score) at weeks 0, 8, 26 and 52, or until the last follow-up. Clinical remission was defined as a partial Mayo score ≤2 and Last observation carried forward (LOCF) and Non responder imputation (NRI) analysis were used. RESULTS: Thirty-six patients were included in the study. With LOCF analysis, remission rates at weeks 8, 26 e 52 were of 41.7%, 47.2% and 47.2%, respectively. With NRI analysis, remission rates at weeks 8, 26 and 52 were of 41.7%, 41.7% and 27.8%, respectively. CONCLUSION: Adalimumab was effective in the treatment of moderate-to-severe ulcerative colitis. Clinical remission was observed in approximately 40% of the patients at weeks 8 and 26, and in almost a quarter of the patients after 1 year of follow up.

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