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P473. Histological inflammation in ulcerative colitis in deep remission under treatment with infliximab

A. Tursi1, W. Elisei2, M. Picchio3, G. Forti4, A. Penna5, P.G. Lecca6, M. Di Fonzo6, L. Di Cesare6, G. Brandimarte6, 1Azienda Sanitaria Locale BAT, Servizio di Gastroenterologia Territoriale, Andria, Italy, 2ASL RMH, Division of Gastroenterology, Albano Laziale, Italy, 3“P. Colombo” Hospital, ASL RMH, Division of Surgery, Velletri, Italy, 4“S. Maria Goretti” Hospital, Digestive Endoscopy Unit, Latina, Italy, 5“S. Paolo” Hospital, Division of Gastroenterology, Bari, Italy, 6“Cristo Re” Hospital, Division of Gastroenterology, Rome, Italy

Background

Mucosal healing, based on histological analysis, is an endpoint of maintenance therapy for patients with ulcerative colitis (UC). There are few data on how histological signs of inflammation develop under treatment with Infliximab (IFX). We investigated the patterns of histological features of inflammation in patients with UC in sustained clinical and endoscopic remission under IFX.

Methods

We performed a retrospective study on 47 patients with UC in clinical and endoscopic remission and undergoing surveillance colonoscopy with biopsies while receiving maintenance therapy with IFX. Each colonic segment was evaluated based on the Mayo endoscopic subscore and the Geboes histology score (range, 0 to 5.4).

Results

Globally, 6110 biopsy specimens were collected from 235 colonoscopies. At the beginning of the follow-up, histological features of inflammation were found in 48.9% of patients receiving maintenance IFX therapy; 25.9% of them had at least moderate inflammation based on histology scores. At the end of the follow-up, when patients were still under endoscopic and clinical remission, 40.4% of patients had at least one biopsy specimen with evidence of any histological inflammation during the follow-up, and 19.1% had biopsy specimens that met the Geboes criteria for abnormal histological inflammation (Figure 1). In none of the different disease locations (pancolitis, left-sided colitis, distal colitis) histological inflammation improved significantly during the follow-up.

Figure 1. Bar graph showing the histological inflammation subdivided according to Geboes score ≥0.1 and Geboes score ≥3.1 at the beginning and at the end of follow-up (p = n.s., Fisher's exact test).

Conclusion

Patients in clinical and endoscopic remission from UC under IFX still frequently have histological features of inflammation.