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P124. The Modified Mayo Endoscopic Score (MMES): a new score for the assessment of extent and severity of endoscopic activity in ulcerative colitis (UC) patients

T. Lobaton Ortega1,2, T. Bessissow3, G. De Hertogh4, G. Van Assche2, S. Vermeire2, P. Rutgeerts2, R. Bisschops5, A. Bitton3, W. Afif6, M. Ferrante2, 1Bellvitge University Hospital, Gastroenterology, Barcelona, Spain, 2University Hospital Leuven, Gastroenterology, Leuven, Belgium, 3MUHC Royal Victoria Hospital, Gastroenterology, Montreal, Canada, 4University Hospital Leuven, Pathology, Leuven, Belgium, 5University Hospital Leuven, Endoscopy, Leuven, Belgium, 6MUHC Royal Victoria Hospital, Gastroenterology, Leuven, Canada

Background

Complete mucosal healing (MH) has become a major endpoint in clinical trials. However, in Crohn's disease, partial mucosal healing has also been associated with a better long-term outcome. Since current endoscopic activity scores for ulcerative colitis (UC) do not take into account the extent and distribution of mucosal inflammation, the effect of partial MH in UC has not been assessed. As a first step, we developed a simple score for UC endoscopic activity, taking into account extent and distribution of mucosal inflammation.

Methods

During endoscopy, the colon was divided into five segments and for each one the operator reported the Mayo endoscopic subscore. The Mayo endoscopic subscores for each segment separately were added to give a Modified Score (MS). The Extended Modified Score (EMS) was obtained by multiplying the MS by the maximal extent of inflammation (in decimeters). The Modified Mayo Endoscopic Score (MMES) was obtained by dividing the EMS with the number of segments with active inflammation (excluding cecal patch). Biopsies were obtained from rectum and sigmoid, as well as from all inflamed segments. Clinical activity was scored according to Mayo partial score and symptomatic remission was defined as Mayo stool frequency of 0–1 and Mayo rectal bleeding of 0. Biological activity was scored according to C-reactive protein (CRP) and fecal calprotectin (FC). Histological activity was scored according to the Geboes' score (GS). Cutt-off values for activity were CRP  ≥5 mg/dL, FC ≥250 µg/g and GS ≥3.1 (presence of neutrophils in the epithelium).

Results

98 UC patients from 2 hospitals were included (median (IQR) age 47 (36–56) years and median disease duration 11 (5–21) years). As shown in Tables 1 and 2, all evaluated endoscopic scores correlated well with Mayo partial score, CRP, FC and GS. Of note, mean MMES scores were significantly different for patients with and without clinical, biological and histological activity. The area under the curve to predict histological activity was 0.86, 0.82, 0.83 and 0.84 for Mayo, MS, EMS and MMES respectively.

Table 1 (abstract P124). Spearman correlations between clinical, biologic, endoscopic and histologic activity
Clinical activity
(partial Mayo score)
Fecal calprotectin (µg/g)CRP (mg/L)Histological activity (Geboes score)
Mayo endoscopic subscore0.618
p < 0.001
0.549
p < 0.001
0.319
p = 0.002
0.734
p < 0.001
MS0.629
p < 0.001
0.554
p < 0.001
0.244
p = 0.020
0.689
p < 0.001
EMS0.551
p < 0.001
0.535
p < 0.001
0.250
p = 0.017
0.652
p < 0.001
MMES0.524
p < 0.001
0.534
p < 0.001
0.276
p = 0.008
0.665
p < 0.001
Histological activity (Geboes score)0.567
p < 0.001
0.525
p < 0.001
0.178
p = 0.199
CRP (mg/L)0.205
p = 0.051
0.481
p < 0.001
Fecal calprotectin (µg/g)0.533
p < 0.001
Table 2 (abstract P124). Association of MMES scores with clinical, biological and histological activity
Mayo endoscopic subscoreMSEMSMMES
Clinical activity (mean±SD)
 No (n = 41)0.6±0.80.9±1.44.5±9.92.2±4.5
 Yes (n = 33)2±1.1 (p < 0.001)3.9±3.1 (p < 0.001)18.5±25.2 (p = 0.003)6.3±5.9 (p = 0.001)
CRP (mg/L) (mean±SD)
 <5 (n = 69)0.9±11.4±1.85.8±11.62.5±4.4
 ≥5 (n = 25)1.9±1.3 (p = 0.003)3.9±3.7 (p = 0.006)22.3±29.8 (p = 0.023)6.3±5.9 (p = 0.012)
FC (µg/g) (mean±SD)
 <250 (n = 50)0.6±0.80.9±1.43.9±9.91.8±4.2
 ≥250 (n = 29)1.9±1.3 (p < 0.001)3.5±3.1 (p < 0.001)17.6±24.6 (p = 0.009)6.4±6.6 (p = 0.002)
Geboes score (mean±SD)
 <3.1 (n = 24)0.3±0.80.5±1.12.1±8.80.7±1.9
 ≥3.1 (n = 28)1.9±1.2 (p < 0.001)3.3±2.9 (p < 0.001)15.3±22.8 (p = 0.002)6.0±6.5 (p < 0.001)

Conclusion

Correlations between the MMES scores and clinical, biological and histological activity were as good as those with the Mayo endoscopic subscore. A longitudinal analysis assessesing the accuracy of evolution in MMES scores to predict long-term response to treatment is ongoing.