P224 The Ulcerative Colitis Endoscopic Index of Severity (UCEIS) is useful to evaluate endoscopic improvement and to predict medium-term prognosis in ulcerative colitis patients treated with tacrolimus.
K. Matsuoka*, E. Saito, T. Fujii, K. Takenaka, M. Nagahori, K. Ohtsuka, M. Watanabe
Tokyo Medical and Dental University, Gastroenterology and Hepatology, Tokyo, Japan
Various scoring systems have been used to assess endoscopic severity in ulcerative colitis (UC). The Ulcerative Colitis Endoscopic Index of Severity (UCIES) is a newly developed scoring system, consisting of vascular pattern, bleeding, and erosions and ulcers. The final score is the sum of these 3 items and ranges from 0 (remission) to 8 (severe). While the UCEIS is a validated scoring system, there has been no study that utilizes the UCEIS in clinical settings. This study aimed to evaluate usefulness of the UCEIS in UC patients treated with tacrolimus.
This was a retrospective cohort study. We enrolled a total of 90 patients treated with tacrolimus at Tokyo Medical and Dental University between September 2009 and August 2014. We used the UCEIS to evaluate endoscopic severity. The Lichtiger score was used to assess clinical response and a Lichtiger score <= 4 was defined as clinical remission.
The mean UCEIS score before treatment was 5.4, with a score of 3-4 in 21 patients (23.3%), 5-6 in 56 patients (62.2%), and 7-8 in 13 patients (14.4%). Fifty-five patients underwent colonoscopy at 3-6 months after initiating tacrolimus. The mean post-therapeutic UCEIS score was 1.5 (range: 0-5), which was significantly lower in patients with clinical remission compared to those who did not achieve clinical remission (0.9 vs. 2.6, p< 0.01). Furthermore, although the pre-treatment UCEIS scores were not correlated with clinical response, patients with a post-therapeutic UCEIS score of 0-1 had a significantly higher rate of medium-term event-free survival, defined as no requirement of either colectomy or other induction therapy, compared with those with UCEIS scores >= 2.
The UCEIS is useful to evaluate endoscopic improvement in UC patients treated with tacrolimus. The UCEIS score of 0 or 1 after treatment is associated with a favorable medium-term outcome, suggesting a possibility that mucosal healing is defined as a UCEIS score of 0 or 1. Thus, the UCEIS is a useful instrument to evaluate UC patients on tacrolimus.