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P157 Usefulness of, and factors influencing, the Ulcerative Colitis Endoscopic Index of Severity for the evaluation of short-term treatment response

K. Kawagishi*, K. Yokoyama, K. Kobayashi

Kitasato University School of Medicine, Gastroenterology, Sagamihara, Japan

Background

The aim of the study was to evaluate colonoscopic findings before and after treatment of active ulcerative colitis (UC) with the use of several endoscopic scores, and clarify factors influencing scores useful for evaluating short-term treatment response.

Methods

Subjects: the study group comprised 42 patients with UC who received infliximab and tacrolimus therapy in our hospital and underwent colonoscopy within 1 month before starting treatment and within 3 months after starting treatment.

Methods: 2 endoscopists evaluated endoscopic findings before and after treatment, using a maximum score of 3 for the 1 item included in the Mayo Endoscopic Score (MES), a maximum score of 8 for the 3 items included in the Ulcerative Colitis Endoscopic Index of Severity (UCEIS), and a maximum score of 16 for the 6 items included in the Endoscopic Activity Index (EAI). We compared endoscopic images of the site with the most severe inflammation before starting treatment with images of the same site after treatment. Clinical treatment outcomes were evaluated using the partial Mayo score (pMs). Responders were defined as patients who had a pMs of 2 or less or a decrease in the score by 3 or more after treatment began. Non-responders were defined as patients who had a decrease in the pMs by 2 or less or a higher score than that before treatment.

Results

First, the median score before treatment was MES 3, UCEIS 5, and EAI 7. After treatment, the median score was MES 2, UCEIS 4, and EAI 5. UCEIS and EAI improved significantly (p < 0.01). The pMs correlated with these 3 scores (correlation coefficient r = 0.711, 0.738, and 0.788, respectively). Second, in responders (n = 24), UCEIS improved from 5 to 3, and EAI improved from 8 to 3 (p < 0.001); however, MES did not improve. In non-responders (n = 19), none of these scores improved. Third, in responders, 2 items of the UCEIS (erosions and ulcers and bleeding) and 3 items of the EAI (depth of ulcer, bleeding, and mucous exudates) improved significantly.

Conclusion

As compared with MES, UCEIS and EAI were more useful for evaluating short-term treatment response. Erosions and ulcers, bleeding, depth of ulcer, and mucous exudates influenced short-term treatment response. Because the EAI is based on 6 items, whereas the UCEIS is based on only 3 items, the UCEIS is more straightforward and can more accurately evaluate treatment response, making it very useful.