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P125. Ultrasensitive C reactive protein is a marker of endoscopic relapse in patients with ulcerative colitis

J. Yamamoto-Furusho1, W. Cedillo-Suárez1, C. Campos-González1, R. Barreto-Zuñiga1, 1IBD Clinic, Instituto Nacional de Ciencias Medicas y Nutricion, Gastroenterology, Mexico, Mexico

Background

The ultrasensitive C reactive protein (hs CRP) is a reactant of acute phase produced by hepatocytes and is regulated by interleukin 1, interleukin 6, tumoral necrosis factor and interferon. The use of hsCRP has been increased in the follow-up of patients with UC. The aim of this study was to determine the role of hsCRP as endoscopic relapse marker in patients with UC and to explore the correlation between hs-CRP and grade of disease activity as well as the IL-6 gene expression in colonic mucosa.

Methods

We evaluated a total of 450 patients with UC belonging to the IBD Clinic at the Instituto Nacional de Ciencias Médicas y Nutrición from January 2007 to December 2011. All patients with UC were in endoscopic remission at the basal colonoscopy and during the follow-up at least one colonoscopy was required. Full Mayo score and hs-CRP were evaluated. According to Mayo score, patients were grouped as remission, mild, moderate, or severe activity. Demographic, clinical and laboratory tests were evaluated in all patients. IL-6 mRNA exprresion was measured from colonic mucosa by Real-time polymerase chain reaction (RT-PCR). The SSPS version 17.0 statistical package was used for the analysis.

Results

The mean age at diagnosis was 31±7 years old, 55.3% were female and 44.7% male. In relation to the extent of disease: 68.2% had pancolitis; 14.1% had distal colitis; 10.6% had proctosigmoiditis and 5.9% had left colitis. In 23.5% extraintestinal manifestations were present characterized by peripherical arthropathy, primary sclerosing colangitis, sacroileitis and uveitis. The medical treatment consisted of aminosalycilates all patients (100%); steroids in 30%, inmunomodulators in 25% and cyclosporin in 2%. The cut-off level of hsCRP was associated with the presence of endoscopic relapse without clinical disease activity: 0.34 mg/dL was associated with mild disease; 0.40 mg/dL for moderate disease and >0.65 mg/dL for severe disease. Nevertheless, 18% of the UC patients continued in endoscopic remission during the follow-up and the cut-off level of hs-CRP was below of 0.15 mg/dL. The levels of hs-CRP correlated significantly with the gene expression of interleukin 6 in the colonic mucosa (r = 0.88, P < 0.0001).

Conclusion

The hsCPR higher than 0.34 mg/dL is a factor associated with the presence of endoscopic relapse in patients with clinical remission of UC. Elevation of hsCRP correlated significantly with the grade of severity and the gene expression of IL-6 in the colonic mucosa.