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* = Presenting author

P249 Clinical significance of endoscopic mucosal healing in patients with ulcerative colitis

K. O. Kim*1, B. I. Jang1, S. H. Shon1, D. E. Jeong1, C. H. Yang2

1Yeungnam University College of Medicine, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Daegu, South Korea, 2Dongguk University College of Medicine, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyungju, Korea, Republic of

Background

Treatment of patients with ulcerative colitis (UC) has traditionally focused on improving symptoms, with the main objective of inducing and maintaining symptomatic remission. Assessing of endoscopic activity and achieving mucosal healing (MH) is considered as an important prognostic factor. The aim of the presents study was to evaluate the clinical significance of mucosal healing in patients with UC.

Methods

The medical records of consecutive 135 patients with UC who were followed-up for more than 6 months and underwent at least 2 or more colonoscopies(CFS) during follow-up duration was reviewed retrospectively. Endoscopic MH was defined as Mayo Endoscopic Score 0 or 1. Disease flare up was defined as new prescription of steroid, medication change, or admission related to the disease. Patients and disease characteristics, use of steroid, and admission history after colonoscopy in patients with MH were compared with those without MH.

Results

Mean age of patients was 46.7 ± 14.9 years. Male to female ratio was 1.6:1. Proctitis, left-side colitis and extensive colitis were 51.1%, 15.6%, and 33.3%, respectively. Amongst them, 68 patients (50.4%) showed MH at colonoscopy during follow-up period. There were 64 cases (47.4%) of Mayo Endoscopic Score 2 and 3 cases (2.2%) of Mayo score 3. There showed no significant difference in baseline characteristics and disease extension between MH group and non-MH group. The rate of steroid usage before CFS was significantly higher in non-MH group. Mean follow-up duration after CFS was 22.63 ± 21.6 months and flare up was noted in 9 cases (13.2%) of MH group and 42 cases (62.7%) of non-MH group. Median interval from colonoscopy to flare up was 9.6 ± 15.5 months in MH and 7.8 ± 12.8 months in the non-MH group (p = 0.876). The steroid usage (p = 0.001), medication change for symptom control (p = 0.001), admission rate of patients (p = 0.001), WBC count, ESR, and CRP after CFS were significantly higher in the non-MH group. There were 2 cases of total colectomy during follow-up, and all of them were in the non-MH group. In patients with flare up, disease duration before CFS was significantly shorter (p = 0.018) and WBC count (0.001) and CRP level (0.001) were significantly higher. The factors associated with disease flare up was no achievement of MH (p = 0.001).

Conclusion

Patients with endoscopic mucosal healing in ulcerative colitis showed less frequent steroid use, medication change for symptom control and admission. They showed better disease course compared with those without MH. Because MH is associated with disease flare up, we need to treat more actively with the goal of endoscopic MH for better long-term outcome