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P164 Which patients are at risk for clinical relapse in ulcerative colitis? A prospective study

P. Boal Carvalho*1, F. Dias de Castro1, M. Barbosa1, S. Monteiro1, T. Cúrdia Gonçalves1, B. Rosa1, M. J. Moreira1, J. Cotter1, 2, 3

1Hospital Senhora da Oliveira, Gastroenterology, Guimarães, Portugal, 2University of Minho, Life and Health Research Institute, Braga/Guimarães, Portugal, 3PT Government Associate Laboratory, ICVS/3B’s, Braga/Guimarães, Portugal

Background

Ulcerative colitis (UC) is an inflammatory bowel disease characterised by periods of remission and periods of relapse. Up to 25% of the patients in remission will present with disease relapse over a 6-month period. We aimed to identify prospectively clinical, analytical, and endoscopic variables associated with an increased risk of short-term clinical relapse in UC patients.

Methods

Prospective, observational study, including consecutive patients previously diagnosed with UC observed at scheduled consultations. Patients under medication for UC, in sustained corticosteroid-free remission, and minimum follow-up of 6 months were included. Clinical and analytical variables were registered at enrolment, as well as recent (< 6 months) endoscopic studies, current medication, and adherence to therapy. Patients were prospectively followed for 6 months, and clinical relapse (defined as the need to change or intensify treatment, hospitalisation or surgery) was assessed. Statistical analysis was performed using SPSS v21.0; p-value < 0.05 was considered statistically significant.

Results

The study included 135 patients, 56.3% female, mean age 44 (± 13) years, and mean disease duration 6.4 (± 4.8) years. Most patients (73%) were non-smokers; 20% were former smokers; and 7% were smokers. Mean laboratorial values were within the normal range, except for C-reactive protein (7.9 ± 6.2 mg/L). Mayo Endoscopic Score was ≤ 1 in 65% of the patients, and > 1 in 35%. Disease extent was classified as proctitis in 47% of the patients, left-sided colitis in 35%, and extensive colitis in 18%. Patients’ medication included aminosalicylates in 91% of the cases, thiopurines in 17%, and anti-tumour necrosis factor (TNF) α agents in 13%.

During follow-up, clinical relapse was observed in 14.1% (n = 19) of the patients; age at enrolment < 40 years (21.8% vs 8.8%, p = 0.032); disease duration < 8 years (17.3% vs 3.2%, p = 0.048); disease flare during the previous year (40.0% vs 12.0%, p = 0.034), Mayo Endoscopic Score > 1 (50.0% vs 3.1%, p < 0.001) and non-adherence to prescribed medication (30.0% vs 11.3%, p = 0.038) were significantly associated with an increased risk of clinical relapse during follow-up.

Conclusion

In this prospective, observational study, in UC patients, there was a 14% incidence of clinical relapse at 6 months. This risk was significantly increased in younger patients (p = 0.032) with a shorter disease duration (p = 0.048), patients with recent disease flares (p = 0.034) or non-adherent to medication (p = 0.038), as well as patients where mucosal healing was not achieved (p < 0.001). In these patients in clinical remission, a lower threshold to intensify or change medication should be considered, and the importance of adherence to treatment should be reinforced.