P310 The efficacy of linked colour imaging, a novel endoscopic enhancement system, for diagnosing mucosal redness in ulcerative colitis patients in clinical remission

Abstract Background Endoscopic mucosal healing is considered as an important therapeutic goal in ulcerative colitis (UC) patients, and several endoscopic evaluations for colonic mucosa such as Mayo endoscopic subscore (MES) and Colitis Endoscopic Index of Severity (UCEIS) are used in clinical practice. Though the strict mucosal healing is defined as MES 0, the relapse of UC has been shown in the patients diagnosed as MES 0. In the present study, we aimed to investigate the efficacy of Linked Color Imaging (LCI), a novel endoscopic enhancement system, to predict long-term prognosis in UC patients diagnosed with MES 0. Methods Twenty-six patients with UC in clinical remission and diagnosed with MES 0 were enrolled. Endoscopic colonic images were assessed by LCI and UCEIS, using a LASEREO endoscopic system (FUJIFILM Co., Tokyo, Japan). Endoscopic LCI images were classified into three subgroups by LCI classification as previously reported. Briefly, LCI patterns were classified as A, no redness; B, redness with visible vessels; and C, redness without visible vessels. Forty months was defined as the time interval between endoscopic diagnosis and relapse of UC. Histological activity was scored according to the Geboes’ score (GS) and the active mucosa was defined by GS>2B.1. Results LCI classification can further subdivide the colonic mucosa diagnosed as MES 0. The patients with LCI-A showed no relapse and the non-relapse rates compared with the patients with LCI-B showed significantly higher (p = 0.033), while the relapse rates of the patients with UCEIS 0 showed no difference compared with UCEIS 1 (p = 0.148). There was no statistical difference in the composition of LCI-A and relapse rate between active and inactive mucosa diagnosed by GS score. Conclusion Endoscopic LCI classification can further subdivide samples diagnosed MES 0. LCI can be a novel and surpassing approach to evaluate mucosal healing and predict the outcome in UC patients.

Download Full-text

Further research on the clinical relevance of the ulcerative colitis colonoscopic index of severity for predicting 5-year relapse

International Journal of Colorectal Disease ◽

10.1007/s00384-021-04009-2 ◽

2021 ◽

Author(s):

Natsuki Ishida ◽

Shunya Onoue ◽

Takahiro Miyazu ◽

Satoshi Tamura ◽

Shinya Tani ◽

...

Keyword(s):

Ulcerative Colitis ◽

Clinical Remission ◽

Colonic Mucosa ◽

Rank Test ◽

Clinical Relapse ◽

Characteristic Analysis ◽

Log Rank Test ◽

Index Of Severity ◽

Time To Relapse ◽

Free Rate

Abstract Purpose The ulcerative colitis colonoscopic index of severity (UCCIS) evaluates the state of the entire colonic mucosa in ulcerative colitis. However, no cut-off values of scores for predicting clinical relapse in patients with ulcerative colitis have been established. This study aimed to determine the cut-off values for predicting clinical relapse in patients with ulcerative colitis. Methods The endoscopic scores (sum of Mayo endoscopic subscores (S-MES) and UCCIS) of 157 patients with ulcerative colitis experiencing clinical remission and their subsequent clinical course were retrospectively reviewed. The optimal cut-off values for predicting relapse and relapse-free rates were analyzed by receiver operating characteristic analysis. Results Forty patients with ulcerative colitis experienced relapse within 24 months. The median UCCIS for these patients at the time of study enrollment was significantly higher than that for patients with clinical remission (P < 0.001). The cut-off value of the UCCIS for predicting relapse was 9.8. The relapse-free rate was significantly lower in patients with UCCIS ≥ 9.8 than in those with UCCIS < 9.8 (log-rank test P < 0.001). For patients who experienced relapse within 5 years, the optimal cut-off values for the UCCIS and S-MES were 10.2 and 1, respectively (P = 0.004). Conclusions The data from this study indicate that the USSIC is a more relevant score than the S-MES for predicting the time to relapse in patients with ulcerative colitis in remission.

Download Full-text

P295. The Ulcerative Colitis Endoscopic Index of Severity is useful to predict medium- to long-term prognosis in ulcerative colitis patients with clinical remission

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjw019.414 ◽

2016 ◽

Vol 10 (suppl 1) ◽

pp. S241.2-S242

Keyword(s):

Ulcerative Colitis ◽

Clinical Remission ◽

Index Of Severity ◽

Long Term Prognosis

Download Full-text

P148 Reproducibility of PICaSSO score by using narrow banding images (NBI) to assess mucosal and histological healing in ulcerative colitis (UC) patients

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.277 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S211-S212 ◽

Cited By ~ 2

Author(s):

R Cannatelli ◽

O Nardone ◽

U Shivaji ◽

S C L Smith ◽

A Bazarova ◽

...

Keyword(s):

Ulcerative Colitis ◽

Roc Curves ◽

Mucosal Healing ◽

Operating Characteristics ◽

Mayo Score ◽

Endoscopic Remission ◽

Histological Activity ◽

Index Of Severity ◽

Virtual Chromoendoscopy ◽

Sensitivity Specificity

Abstract Background The endoscopic and histological healing are key therapeutic targets in ulcerative colitis(UC) patients. PICaSSO (Paddington International virtual ChromoendoScopy ScOre)1,2 is a new Virtual Chromoendoscopy Endoscopic (VCE) score to better define mucosal healing by mucosal and vascular features. Originally validated using iSCAN platform, the aim of this study was to evaluate the reproducibility of PICaSSO with NBI near focus platform and to assess if this could predict histological healing. Methods We prospectively studied 78 UC patients (mean age 43.4 years, 52.6% male) who underwent colonoscopy for colitis assessment or surveillance using NBI near focus (Olympus, Japan). Endoscopic activity was assessed by using ulcerative colitis Endoscopic Index of Severity (UCEIS) and PICaSSO; whilst histological activity was scored by the Robarts Histology Index (RHI). ROC curves were performed to evaluate sensitivity, specificity and accuracy of endoscopy scores to predict histological healing. Results Out of 78 patients, 47 (60.3%) were in clinical remission according to the partial Mayo score. 28(35.9%) and 32(41.0%) were in endoscopic remission according to UCEIS≤1 and PICaSSO≤3, respectively. The best cut-off of UCEIS to predict histological healing was less or equal to 1. Sensitivity, specificity and accuracy were 84.6% (95% CI 63.5, 96.4), 88.5% (95% CI 70.1, 97.8) and 87.2% (95% CI 75.6, 93.6), respectively. The Area Under the ROC curve (AUROC) was 93.3% (95% CI 88.2, 98.3). The best threshold of PICaSSO in the prediction of histological healing was less or equal to 3. PICaSSO ≤ 3 have sensitivity of 96.2% (95% CI 76.9, 100), specificity of 86.5% (95% CI 67.3, 96.2) and accuracy of 89.7% (95% CI 77.6, 96.2) to predict histological healing, estimated as RHI ≤ 3. The AUROC was 95.3% (95% CI 91.1, 99.5). Conclusion PICaSSO VCE score can be easily and accurately reproduced with NBI near focus platform and it has better operating characteristics than UCEIS to predict histological healing defined by RHI. Reference

Download Full-text

P640 Moderate to severe endoscopic inflammation is frequent after clinical remission in pediatric ulcerative colitis: A cause for disease extension and relapse?

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.768 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S530-S531

Author(s):

C Sarbagili Shabat ◽

D Weiner ◽

J Wardi ◽

L Abramas ◽

M Yaakov ◽

...

Keyword(s):

Ulcerative Colitis ◽

Clinical Remission ◽

Mucosal Healing ◽

Current Therapy ◽

Sustained Remission ◽

High Relapse Rate ◽

Mayo Score ◽

Remission Rates ◽

Disease Extension ◽

Relapse Rates

Abstract Background Pediatric ulcerative colitis (UC) is characterised by low sustained remission rates and frequent extension of disease even if clinical remission is obtained. Current therapy in pediatric UC is driven primarily by clinical response. Extension of disease and high relapse rates may be due to a failure to obtain mucosal healing with treatment despite clinical remission. Our aim was to evaluate this possibility by assessing endoscopic disease activity after remission was obtained. Methods Pediatric UC patients with clinical remission, defined as sustained PUCAI < 10 three months after remission was obtained, were prospectively assessed for mucosal healing by endoscopy. Mayo score was assessed for each segment by a blinded adult gastroenterologist using central reading. Results 41 children were enrolled after informed consent, 7 were excluded because of a PUCAI score 10–15 at the time of sigmoidoscopy. Thirty-four Sigmoidoscopies were performed 12–20 weeks after reporting clinical remission. Mucosal healing Mayo 0 was present in 15 endoscopies (44%), Mayo 1 was present in 2 endoscopies (6%) and moderate to severe endoscopic scores Mayo 2–3 was present in 17 endoscopies (50%). Conclusion About 50% of children assessed for mucosal healing 3–5 months after clinical remission is obtained have residual moderate to severe inflammation. Inadequate endoscopic improvement despite clinical remission may explain disease extension and the high relapse rate in children.

Download Full-text

The Ulcerative Colitis Endoscopic Index of Severity is Useful to Predict Medium- to Long-Term Prognosis in Ulcerative Colitis Patients with Clinical Remission

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjw104 ◽

2016 ◽

Vol 10 (11) ◽

pp. 1303-1309 ◽

Cited By ~ 32

Author(s):

Mari Arai ◽

Makoto Naganuma ◽

Shinya Sugimoto ◽

Hiroki Kiyohara ◽

Keiko Ono ◽

...

Keyword(s):

Ulcerative Colitis ◽

Clinical Remission ◽

Index Of Severity ◽

Long Term Prognosis

Download Full-text

Increased Mucosal IL-12 Expression is Associated with Relapse of Ulcerative Colitis

10.21203/rs.3.rs-140158/v1 ◽

2021 ◽

Author(s):

Kazuhiko Uchiyama ◽

Tomohisa Takagi ◽

Katsura Mizushima ◽

Mariko Kajiwara-Kubota ◽

Saori Kashiwagi ◽

...

Keyword(s):

Ulcerative Colitis ◽

Mrna Expression ◽

Real Time Pcr ◽

Clinical Remission ◽

Mucosal Healing ◽

Histological Activity ◽

Rectal Biopsies ◽

Relapse Group

Abstract Background: The role of IL-12/23 in the pathogenesis of ulcerative colitis (UC) is unclear. We analyzed mucosal IL-12/23 expression and its relationship with endoscopic severity, histological activity, and UC relapse.Methods: Rectal biopsies were collected from 70 UC patients with clinical remission. IL-12, IL-23, IFN-g, IL-17A, and IL-17F mRNA expression was measured by real-time PCR. Endoscopic severity and histological activity were evaluated using the Mayo endoscopic subscore (MES) and the Geboes score, respectively. Results: The longest follow-up period was 51 months. Thirty-four patients relapsed during the study period. Samples from these subsequently relapsed patients formed the “relapse” group, while those from patients that did not relapse formed the “remission” group. IL-12 (P=0.0003) and IL-23 (P=0.014) mRNA expression was significantly higher in the relapse than the remission group. Expression of IL-23 (P=0.015) but not IL-12 (P=0.374) was correlated with MES. However, in patients with an MES of 0 and 1, IL-12 expression was statistically higher in the relapse than the remission group (P=0.0015, P=0.0342). IL-12 and IL-23 expression did not vary significantly between histologically active and inactive mucosa; both were higher in histologically inactive patients in the remission group (IL-12: P=0.0002, IL-23: P=0.046).Conclusions: Rectal IL-12 and IL-23 expression was elevated in the relapse group, but IL-12 was more strongly associated with UC relapse, irrespective of endoscopic severity and histological activity. Mucosal IL-12 was elevated in patients with deep mucosal healing. Our results suggest an important role of IL-12 in UC pathogenesis and the molecular mechanism of UC relapse.

Download Full-text

Effect of disease duration on the association between serum albumin and mucosal healing in patients with ulcerative colitis

BMJ Open Gastroenterology ◽

10.1136/bmjgast-2021-000662 ◽

2021 ◽

Vol 8 (1) ◽

pp. e000662

Author(s):

Sen Yagi ◽

Shinya Furukawa ◽

Kana Shiraishi ◽

Yu Hashimoto ◽

Kazuhiro Tange ◽

...

Keyword(s):

Ulcerative Colitis ◽

Serum Albumin ◽

Clinical Outcomes ◽

Clinical Remission ◽

Acute Inflammation ◽

Japanese Patients ◽

Cross Sectional Study ◽

Mucosal Healing ◽

High Serum ◽

Cross Sectional

ObjectiveSerum albumin is used as a marker of acute inflammation. Several studies have addressed the association between serum albumin and clinical outcome in patients with ulcerative colitis (UC). While mucosal healing (MH) has been indicated as the therapeutic goal for UC, the association between serum albumin and MH remains unclear. We evaluated this issue in patients with UC overall and explored whether duration of UC affected this association.DesignThis cross-sectional study recruited consecutive patients with UC. Study subjects consisted of 273 Japanese patients with UC. Serum albumin was divided into tertiles based on its distribution in all study subjects. One endoscopy specialist was responsible for measuring partial MH and MH, which were defined as a Mayo endoscopic subscore of 0–1 and 0, respectively. The association between serum albumin and clinical outcomes was assessed by multivariate logistic regression.ResultsRates of clinical remission, partial MH and MH were 57.9%, 63% and 26%, respectively. Only high serum albumin (>4.4 mg/dL) was significantly positively associated with MH (OR 2.29 (95% CI: 1.03 to 5.29), p for trend=0.043). In patients with short UC duration (<7 years) only, high serum albumin was significantly positively associated with MH and clinical remission. In patients with long UC duration (≥7 years), in contrast, no association between serum albumin and clinical outcomes was found.ConclusionIn Japanese patients with UC, serum albumin was significantly positively associated with MH. In patients with short UC duration, serum albumin might be a useful complementary marker for MH.

Download Full-text