P146 Risk factors of clinical relapse in patients with ulcerative colitis in clinical and endoscopic remission.
M. Calafat*1, T. Lobatón1, A. Hernández-Gallego2, M. Mañosa1, P. Torres-Rodriguez1, E. Cabré1, I. Ojanguren2, E. Domènech1
1Hospital Universitari Germans Trias I Pujol, Department of Gastroenterology CIBEREHD, Badalona, Spain, 2Hospital Universitari Germans Trias i Pujol, Department of Pathology, Badalona, Spain
Patients with ulcerative colitis (UC) in endoscopic remission have improved disease outcome with fewer complications. It has been suggested that histological features have a prognostic value in the outcome of these patients. Our aim was to assess the role of histology as a risk factor for clinical relapse in patients with UC in clinical and endoscopic remission.
This was a retrospective observational study including patients with left/extensive UC who underwent a colonoscopy with biopsies between January 2005 and June 2014 and were in clinical remission (partial Mayo score 0–1, without rectal bleeding) and endoscopic remission (Mayo endoscopic sub-score 0–1) while on stable treatment and free of steroids within the previous 3 months. Regarding histology, basal plasmacytosis, the presence of intraepithelial neutrophils (acute activity), the architectural alterations, and an increased mononuclear infiltrate were evaluated. Other variables, including UC flare within 12 months before inclusion, Mayo endoscopic sub-score grade 1, biological activity (increased C-reactive protein), and treatment at the time of endoscopy, were also analysed as potential risk factors of clinical relapse. Clinical relapse was defined as the presence of symptoms together with the need for treatment optimisation.
Included were 157 patients: 38% women; median age 54 years (IQR 44-65); 65% with extensive UC; 87% with Mayo endoscopic sub-score = 0; and 18% presented a flare within 12 months before inclusion. Median time in clinical remission before the inclusion was 38 months (IQR 19–105) and median time of follow-up was 39 months (IQR 18–64). Further, 31% presented clinical relapse during follow-up with a median time for relapse of 3.3 years (IQR 1.55–5.4). The cumulative probability of clinical relapse at 1, 3, and 5 years was 7%, 22%, and 29%. Regarding histology, 10%, 17%, 54%, and 60% presented basal plasmocytosis, acute activity, architectural changes, and mononuclear infiltrate, respectively. In the multivariate analysis (Cox), acute activity and flare within 12 months before inclusion showed a significant association with clinical relapse at 12 months of follow-up (RR = 7.69; 95% CI 2.03–29.05 p = 0.003-). Similar results were obtained when considering the entire follow-up period (RR = 1.97; 95% CI 1.01–3.82 p = 0.046-).
In UC patients in clinical and endoscopic remission, the presence of intraepithelial neutrophils in colonic biopsies and a shorter time of clinical remission constitute risk factors for clinical relapse. A closer monitoring is therefore recommended in these patients. Further prospective studies need to clarify whether treatment optimisation is justified in this context.