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P612. Influence of mucosal healing in clinical course of ulcerative colitis

Background

Mucosal healing has become a common endpoint in most therapeutic trials and an important objective that we try to assess in ulcerative colitis (UC) patients. Data regarding the influence of mucosal healing in the clinical course of UC is limited due to the absence of prospective studies. The aim of this study is to evaluate the influence and the prognostic value of mucosal healing in UC patients.

Methods

A prospective observational cohort study was designed. All UC patients who presented mucosal healing in a colonoscopy were consecutively included and classified according to the Montreal Classification. Mucosal healing was defined as an endoscopic Mayo sub-score of 0 or 1, in accordance with the most significant UC trials. In order to avoid interpretation bias, all colonoscopies were performed and scored by the same endoscopist, specialised in inflammatory bowel disease endoscopy. Clinical relapse was defined as requirement of remission induction treatment, any treatment escalation, hospitalisation or colectomy. In order to assess the clinical course of UC, over a follow-up period of 12 months all clinical relapses were recorded and evaluated at months 6 and 12. The influence of demographic variables (gender, tobacco and extension of the disease) in the clinical course of UC patients was also evaluated. Results are shown as percentages, and were analysed by the chi-square test and the Fisher exact test, where appropriate.

Results

187 UC patients were included: 94 male (50.3%), mean age 52 years, ages ranging from 22 to 85. 31.3% of patients were E1, 42.2% E2 and 26.5% E3 according with the Montreal Classification. Regarding smoking habits, 17.1% were currently smokers, 28.1% former smokers and 54.7% non-smokers. During the first 6 months most patients maintained remission after mucosal healing (81.8%) and only 34 patients (18.2%) presented a relapse. During the following 6 months (from 6 to 12) 15.5% of patients presented a relapse. Despite more E2 patients (10.8%) than E1 (3.6%) and E3 (4.2%) presenting a relapse in the first 6 months, differences were not statistically significant (p = 0.14). Regarding tobacco, 8.8% of non-smokers, 6.1% of former smokers and 3.9% of current smokers presented a clinical relapse in the 6 months following mucosal healing, without statistically significant differences among the three groups (p = 0.60).

Conclusion

This study demonstrated that mucosal healing is associated with clinical remission and a favourable prognosis in UC. The extension of the disease does not have any influence over maintenance of remission in patients who had achieved mucosal healing.

  • Written by:

    M. Barreiro-de Acosta, N. Vallejo, D. de la Iglesia, L. Uribarri, I. Baston, R. Ferreiro, A. Lorenzo, J.E. Dominguez-Muñoz, University Hospital Santiago de Compostela, Gastroenterology, Santiago, Spain