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P168. The majority of patients with inflammatory bowel disease in clinical remission has mucosal inflammation

J.E. Baars1, V.J.A.A. Nuij1, B. Oldenburg2, E.J. Kuipers1, C.J. van der Woude1

1Erasmus MC, Rotterdam, The Netherlands; 2University Medical Center Utrecht, Utrecht, The Netherlands

Background and Aims: Routine endoscopic examination of inflammatory bowel disease (IBD) patients in clinical remission often reveals mucosal inflammation. The clinical relevance of this finding is debated. We assessed the prevalence and severity of mucosal inflammation in IBD patients during clinical remission, the clinical consequences, and the impact on the disease course.

Methods: All IBD patients from two Dutch referral centers who were in clinical remission and underwent a surveillance colonoscopy from 01/2001 to 12/2003 were included. Follow-up ended May 1st, 2009. Clinical data were collected from patient charts. Endoscopies and histology were reviewed. Statistical analysis was performed using independent t-tests, and nonparametric tests.

Results: We identified 152 IBD patients (98 (65%) ulcerative colitis, 46 (30%) Crohn's disease, 8 (5%) unclassified colitis; 85 (56%) males). Median follow-up time was 6.8 years (IQR 6–8). One-hundred and five patients had evidence of mucosal inflammation: 51 (49%) had both endoscopic and histological inflammation (group A), 51 (49%) had histological inflammation only (group B), 2 (2%) patients had endoscopic lesions only. In 88% (n = 92) treatment was not changed thereafter. Treatment was more frequently altered in group A than in group B (24% vs 4%; p = 0.004). On follow up endoscopy, two years after the index procedure 29% of all patients had endoscopic inflammation, and another 27% had only microscopic inflammation. Patients in group A+B had more often inflammation (n = 63/100, 63%) two years later than those without asymptomatic inflammation (n = 14/40, 38%), p = 0.21. Additionally, they had a more severe inflammation, both endoscopic and histological (p = 0.04/p = 0.001) than those without inflammation. In 39% (n = 36) the inflammation resolved spontaneously. However, inflammation was not associated with more frequent clinical relapses nor with stricture formation or the need for surgery.

Conclusions: A large proportion of IBD patients has mucosal inflammation without clinical symptoms. Although one third recovered without a change of therapy, inflammation, either endoscopic or histological, in patients who are clinically in remission is associated with more severe mucosal disease activity at two years follow-up. However, this did not translate in more complications or symptomatic flares during a 7 years follow-up.