P335 Treatment strategies after mucosal healing (MH) in ulcerative colitis

Abstract Background MH and deep remission are the major therapeutic goals in the treatment of ulcerative colitis (UC), but the best therapeutic strategy after reaching MH in terms of maintenance or de-escalation is still poorly defined. This retrospective study aimed to evaluate the maintenance of remission in patients who maintained therapy vs. patients de-escalating treatment. Methods Data of patients with UC who reached mucosal healing were retrospectively investigated. Demographic data/gender, age), disease-related data (extension, duration, age at onset), together with data on smoking behaviour and on therapy after reaching MH were collected. MH was defined as an endoscopic Mayo score of 0. The primary endpoint was clinical relapse regardless of therapeutic regimen. The outcome of patients maintained on therapy was compared with patients who de-escalated therapy and to patients with mild disease maintained on mesalazine. Results One hundred thirty-five patients with MH were followed for a mean time of 94 months (SD 57.2) and divided into 3 groups: group 1 (de-escalation; 45 patients), in which MH was reached with IMM or biologics and therapy was continued with only mesalazine, group 2 (no de-escalation; 40 patients) in which MH was reached with IMM or biologics, group 3 (only treatment with 5-ASA; 50 patients). In the 3 groups, disease relapse occurred in 62%, 30% and 38% respectively in a mean time of 22, 25 and 36 months. Patients who de-escalated therapy were more likely to relapse than patients who maintained initial treatment (p = 0.003, log-rank test)(Figure 1). A subgroup analysis showed as only for MH reached with anti-TNFs de-escalation strategy was related to an increasing risk of relapse (p = 0.003). No risk factors for relapse were identified on multivariate analysis. Conclusion Maintaining treatment after MH is reached represents the best strategy to maintain remission. Patients on anti-TNFs were more likely to relapse after de-escalation. An evaluation on pharmacoeconomics seems to be advised in order to identify a more sustainable strategy.

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P696 The usefulness to treatment enhancement for the patients of ulcerative colitis with clinical remission diagnosed as Mayo endoscopic subscore 1

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.824 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S564-S564

Author(s):

M Kubota Kajiwara ◽

K Uchiyama ◽

Y Azuma ◽

R Yasuda ◽

S Takayama ◽

...

Keyword(s):

Ulcerative Colitis ◽

Treatment Group ◽

Clinical Remission ◽

Clinical Symptoms ◽

Mucosal Healing ◽

Endoscopic Examination ◽

Clinical Relapse ◽

Oral Medicine ◽

Clinical Background ◽

Observation Period

Abstract Background In many clinical trials of ulcerative colitis (UC), Mayo endoscopic subscore (MES) has been used to diagnose mucosal healing to evaluate the effectiveness of various treatment. Although both MES 0 and MES 1 were defined as the endoscopic mucosal healing, several studies reported that the risk of clinical relapse was significantly higher in the patients diagnosed as MES 1 compared with MES 0. However, it has not been established the beneficial effect to escalate the treatment for the patients diagnosed as MES 1 to avoid clinical relapse. In the present study, we retrospectively investigated the effectiveness about the escalation of treatment for UC patients with clinical remission diagnosed as MES 1. Methods A total of 68 patients with UC diagnosed as clinical remission (4 and under of Lichtiger CAI score) between April 2014 to October 2019 were enrolled in this study. All patients were endoscopically diagnosed as MES 1 and observation period was 12 months from the time of endoscopy. Relapse of UC was defined as the need for more aggressive treatment for UC due to aggravation of clinical symptoms or endoscopic findings. The relapse ratio was compared between the patients who continued the same treatment and the patients who had enhanced treatment. Enhanced treatment was defined as additional oral medicine or local preparations including enemas, suppositories, and foams within 3 months from endoscopic examination. Results In 68 patients, 12 patients were received enhanced treatment and 56 patients were continued the same treatments. There were no significant differences in clinical background between the two groups such as mean age (enhanced treatment group vs. same treatment group: 47.9 years vs. 42.9 years), disease type, disease duration (110.3 months vs. 94.8 months), and disease activity (Lichtiger CAI score: 2.5 vs. 2.8). The group of the enhanced treatment included 8 patients with oral 5-aminosalicylates escalation and 4 patients with additional local preparations. The relapse ratio was higher in patients with same treatment group (0%) compared with enhanced treatment group (14.3%). Conclusion Our results indicate that the enhancement of the treatment for UC patients with clinical remission diagnosed as MES 1 is effective to avoid relapse.

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Faculty Opinions recommendation of Prognostic value of serologic and histologic markers on clinical relapse in ulcerative colitis patients with mucosal healing.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717968904.793468528 ◽

2013 ◽

Author(s):

Richard Gearry

Keyword(s):

Ulcerative Colitis ◽

Prognostic Value ◽

Mucosal Healing ◽

Clinical Relapse

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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.

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Histological Markers of Clinical Relapse in Endoscopically Quiescent Ulcerative Colitis

Inflammatory Bowel Diseases ◽

10.1093/ibd/izz308 ◽

2019 ◽

Vol 26 (11) ◽

pp. 1722-1729 ◽

Cited By ~ 5

Author(s):

David Kevans ◽

Richard Kirsch ◽

Callum Dargavel ◽

Boyko Kabakchiev ◽

Robert Riddell ◽

...

Keyword(s):

Ulcerative Colitis ◽

Mucosal Healing ◽

Mucosal Inflammation ◽

Clinical Relapse ◽

Disease Relapse ◽

Mayo Score ◽

Therapeutic Decisions ◽

First Relapse ◽

Histological Activity

Abstract Background In ulcerative colitis (UC) patients who have achieved mucosal healing, active microscopic colonic mucosal inflammation is commonly observed. We aimed to assess the association between histological activity and disease relapse in endoscopically quiescent UC. Methods Ulcerative colitis patients with endoscopically quiescent disease and ≥12 months of follow-up were included. Biopsies were reviewed for the presence of basal plasmacytosis (BPC) and active histological inflammation, defined as a Geboes score (GS) ≥3.2. Primary outcome measures were disease relapse at 18 months and time to first relapse after index colonoscopy. Results Seventy-six UC patients (51% male; mean age, 38.6 years; median follow-up [range], 75.2 [2–118] months) were included. Sixty-two percent had an endoscopic Mayo score of 0 at index colonoscopy. Basal plasmacytosis was present in 46% and active histological inflammation in 30% of subjects. Presence of BPC was associated with a significantly shorter time to disease relapse (P = 0.01). Active histological inflammation was significantly associated with clinical relapse at 18 months (P = 0.0005) and shorter time to clinical relapse (P = 0.0006). Multivariate analysis demonstrated active histological inflammation to be independently associated with clinical relapse at 18 months and time to clinical relapse. Conclusions In endoscopically quiescent UC, active histological inflammation and the presence of BPC are adjunctive histological markers associated with increased likelihood of disease relapse. Although prospective studies are required, the presence of these histological markers should be a factor considered when making therapeutic decisions in UC.

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Prognostic Value of Serologic and Histologic Markers on Clinical Relapse in Ulcerative Colitis Patients With Mucosal Healing

The American Journal of Gastroenterology ◽

10.1038/ajg.2012.301 ◽

2012 ◽

Vol 107 (11) ◽

pp. 1684-1692 ◽

Cited By ~ 154

Author(s):

Talat Bessissow ◽

Bart Lemmens ◽

Marc Ferrante ◽

Raf Bisschops ◽

Kristel Van Steen ◽

...

Keyword(s):

Ulcerative Colitis ◽

Prognostic Value ◽

Mucosal Healing ◽

Clinical Relapse

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IMPORTANCE OF NANOCARRIERS AND PROBIOTICS IN THE TREATMENT OF ULCERATIVE COLITIS

International Journal of Applied Pharmaceutics ◽

10.22159/ijap.2021v13i1.37510 ◽

2021 ◽

pp. 77-85

Author(s):

VANDANA THAKUR ◽

BHUPENDRA SINGH ◽

ANKITA SHARMA ◽

NISHA KUMARI ◽

INDER KUMAR ◽

...

Keyword(s):

Ulcerative Colitis ◽

Side Effects ◽

Wide Spectrum ◽

Gastrointestinal Diseases ◽

Mucosal Healing ◽

Aminosalicylic Acid ◽

Bowel Distension ◽

Inflammatory Reactions ◽

Therapeutic Goals

Ulcerative colitis (UC) is an inflammatory chronic disease primarily affecting the colonic mucosa; the extent and severity of colon involvement are variable. Ulcerative colitis is identified by mucus diarrhea, tenesmus, bowel distension, and anemia. 5-aminosalicylic acid drugs, steroids, and immune suppressants are used for the therapy of ulcerative colitis. The mainchallenges in the management of thediseaseare drug-related side-effects and local targeting. To overcome these challengesprobiotics and micro and Nanoparticulate systemauspiciousapproaches to overcome drug-related adverse side effects and local targeting.Upon ingestion, the probiotics can result in beneficial health effects. Probiotics and micro and nanoparticulate approaches for suitable targeting and overcome the drug-associated side effect. Probiotics are mainly used as gut modulators but are also nowadays explored for their use in ulcerative colitis.The current therapeutic goals are to achieve clinical remission along with mucosal healing, avoidance of complications such as side effects of the drug and to improve the quality of life. The use of probiotics to increase the health of the intestine and used to block or manage intestinal disorders. They may prevent the induction of inflammatory reactions. Probiotics must be inspected for efficacy in the prevention and management of a wide spectrum of gastrointestinal diseases, like antibiotic-associated diarrhea.Micro and Nanoparticulate drug delivery system has been achieving huge importance for targeting of the drug to colon locally at a controlled and sustained rate.

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P411 Baseline Hypertrophy of the Submucosa at intestinal ultrasound predicts Failure of Treatment in patients with ulcerative colitis

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.535 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S418-S419

Author(s):

F de Voogd ◽

M Duijvestein ◽

C Ponsioen ◽

M Löwenberg ◽

G D’Haens ◽

...

Keyword(s):

Ulcerative Colitis ◽

Layer Thickness ◽

Activity Index ◽

Age At Onset ◽

Muscularis Propria ◽

Fecal Calprotectin ◽

Mucosal Healing ◽

Wall Layer ◽

Signal Loss

Abstract Background Submucosal fibrosis in ulcerative colitis (UC) has been associated with disease severity in colectomy specimens. As intestinal ultrasound (IUS) visualizes all individual wall layers, we aimed to evaluate baseline IUS features to determine endoscopic response and investigate changes in wall layers during anti-inflammatory treatment in patients with UC Methods Moderate-severe UC patients (endoscopic Mayo score (EMS)≥2) extending beyond the rectum starting treatment were included. Simple Clinical Colitis Activity Index (SCCAI), fecal calprotectin (FCP), IUS and endoscopy were performed at baseline and at follow-up between week 8 and 26. BWT, individual wall layer thickness (WT) (mucosa (MC), submucosa (SM) and muscularis propria (MP)) and ratios among layers, Colour Doppler Signal, loss of haustrations, loss of stratification and hyperechogenicity of the submucosa (HoS) (Figure 1) were scored for the sigmoid colon (SC). EMS was assessed for the SC: endoscopic remission (ER) was defined as EMS=0 and endoscopic improvement (EI) as EMS≤1. For statistical analysis a paired t-test and X2-test were used. Results 49 patients were included of whom 61% failed ≥1 biological. 59% started tofacitinib and 41% started a biological. At follow-up, 30% and 49% reached ER and EI, respectively. BWT decreased significantly when ER (2.32 ± 1.63 mm vs 1.00 ± 1.98 mm, p=0.034) or EI (2.53 ± 1.66 mm vs 0.30 ± 1.58 mm, p<0.0001) was reached. In patients with ER and EI, the SM thickness showed significantly more pronounced decrease compared to the other wall layers (Table 1 and Figure 2). Baseline presence of HoS (29% of patients) predicted failure of treatment (ER: OR: 0.10, 95% CI: 0.01-0.87, p=0.014, EI: OR: 0.16, 95% CI: 0.04-0.65, p=0.008,). Furthermore, when HoS was present, SCCAI (7.33 ± 3.62 vs 9.75 ± 3.23, p=0.023) and FCP (1249 ± 903 µg/g vs 2494 ± 2277 µg/g, p=0.008) were significantly lower at baseline. Also, patients with HoS more frequently failed one (OR: 4.44, 95% CI: 1.08-18.32, p=0.03) or multiple biologicals (OR: 5.63, 95% CI: 1.54-20.52, p=0.009). However, disease duration (p=0.950) or age at onset (p=0.853) did not differ between groups. Conclusion This is the first study showing that HoS on IUS is a predictor of endoscopic non-response to biologicals and tofacitinib in patients with UC. Additionally, changes in SM layer thickness is the most important component of the total bowel wall when evaluating mucosal healing on IUS.

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P118 A comprehensive evaluation of mucosal redness in patients with ulcerative colitis by linked colour imaging

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.247 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S195-S195

Author(s):

K Uchiyama ◽

M Kubota ◽

Y Azuma ◽

R Yasuda ◽

T Shun ◽

...

Keyword(s):

Ulcerative Colitis ◽

White Light ◽

Clinical Symptoms ◽

Comprehensive Evaluation ◽

Mucosal Healing ◽

Clinical Relapse ◽

Light Image ◽

Colon And Rectum ◽

Long Term Prognosis ◽

Relapse Group

Abstract Background Mucosal healing is important for the patients of ulcerative colitis (UC) to avoid clinical relapse and developing colitic cancer. Though Mayo endoscopic subscore (MES) has been widely used to evaluate mucosal healing of UC patients, it is not enough to predict relapse. We have reported the new endoscopic evaluation by linked colour imaging (LCI) that enhances mucosal redness and can predict relapse with more precision compared with MES1). However, the diagnosis in both MES and LCI depends on the local lesion and it has not been established the comprehensive evaluation because mucosal redness is not clearly recognised by white light image. In the present study, we examined the comprehensive evaluation of mucosal redness in the patients of UC by LCI and investigate the relation with long-term prognosis. Methods All examinations were carried out with an EG-L590WR endoscope and a LASEREO endoscopic system (FUJIFILM Co., Tokyo, Japan) including 47 UC patients (pan colitis type) with clinically remission (Under 4 of Lichtiger CAI score). Each part of the large intestine (ascending colon, transverse colon, descending colon, sigmoid colon and rectum) was observed with LCI and WLI (white light image), and the area of redness (regardless of strength) was evaluated. The score was marked 0, 1, 2 and 3, in case of the area of redness is 0%, <50%, 50% or higher and 100%, respectively. The score of each part was totalled (total redness score), and the relapse rate for 1 year after the endoscopy was investigated. Relapse of ulcerative colitis was defined as the need for more aggressive medication for ulcerative colitis due to aggravation or clinical symptoms, or aggravation of endoscopic findings. Results The relapse ratio was 19.1% (9/47 cases). The average of total redness score by LCI was 4.02 ± 2.25 and total redness score by WLI was 3.11 ± 2.5. The average of total redness score by LCI in the patients with no relapse group was 3.94 ± 2.21, on the other hand, with relapse group was 4.33 ± 2.23 (p = 0.0354). However, total redness score measured by WLI showed no statistical difference between no relapse group and relapse (p = 0.278). Conclusion A comprehensive evaluation of mucosal redness using LCI is useful approach to predict relapse for UC patients with clinical remission.

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The albumin to globulin ratio is associated with mucosal healing in Japanese patients with ulcerative colitis: A cross-sectional study

10.21203/rs.3.rs-144470/v1 ◽

2021 ◽

Author(s):

Sen Yagi ◽

Shinya Furukawa ◽

Kana Shiraishi ◽

Masakazu Hanayama ◽

Kazuhiro Tange ◽

...

Keyword(s):

Ulcerative Colitis ◽

Age At Onset ◽

Japanese Patients ◽

Mucosal Healing ◽

Confounding Factors ◽

C Reactive Protein ◽

Cross Sectional ◽

Reactive Protein ◽

Protein Group ◽

Albumin To Globulin Ratio

Abstract Background Ulcerative colitis (UC) is a chronic inflammatory disease. Mucosal healing (MH) is inversely associated with clinical outcome. The albumin to globulin ratio (AGR) is known as chronic inflammation marker. While some evidence regarding an association between AGR and some chronic diseases has been reported, no evidence regarding association between AGR and UC exists. The aim of this study to evaluated the association between AGR and MH among Japanese patients with UC. Methods The study subjects consisted of 273 Japanese patients with UC. AGR was divided into quartiles on the basis of the distribution of all study subjects. One endoscopic specialist was responsible for evaluating MH, which was defined as a Mayo endoscopic subscore of 0 or 0–1. Age, sex, steroid use, body mass index, age at onset of UC, and anti-TNFα preparation were selected a priori as potential confounding factors. Results The mean age was 51.2 years, and the percentage of male patients was 59.0%. The percentage of MH was 26.4%. High AGR (1.483 < AGR ≤ 1.643) and very high AGR (> 1.643) was significantly positively associated with MH (OR 2.21 [95% CI: 1.12–4.47], p for trend = 0.001) after adjustment for confounding factors. No association between AGR and partial MH was found. The independent positive association between AGR and MH was found in only low C-reactive protein group. Conclusion Among Japanese patients with UC, AGR was significantly positively associated with MH, was significantly positively associated with MH especially in the low C-reactive protein group.

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