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* = Presenting author

P606 Histological healing in ulcerative colitis with mesalazine and its prognostic role

G. Frieri*, B. Galletti, M. Di Ruscio, R. Tittoni, A. Capannolo, G. Latella, L. Sollima, P. Leocata, S. Necozione, A. Viscido

University Of L’Aquila, L’Aquila, Italy

Background

Histological healing (HH) of colonic mucosa is becoming increasingly recognised as the major therapeutic target in ulcerative colitis (UC). The Aim was to assess HH in UC patients submitted to maintenance treatment with high dosage of mesalazine (5ASA) and to evaluate its prognostic value.

Methods

This prospective cohort study included 56 patients who were able to maintain remission with high dosage of 5ASA for at least 1-year (oral ≥ 3.2g/day plus topical 4g/day for at least 3 times in a week) after a course of steroids, 3 months earlier. Steroid resistant/dependent patients were excluded. All patients underwent endoscopy with biopsies 12 months after starting maintenance treatment. The histological inflammation was compared with that present at the time of active disease and scored using the Mount Sinai Histological Activity Index (HAI) (score from 0 to 3). HH was defined as a HAI score of 0; histological improvement was considered as a score of 1. Subsequently, the need of steroids in the year following the histological evaluation was considered. Statistical analysis was performed using Wilcoxon and χ2 tests.

Results

Median histological inflammation significantly improved at 12 months (p < 0.0001). At the time of active disease 20 pts showed HAI = 3, 36 HAI = 2, no patients HAI 1 or 0. At the 12 months follow-up, 2 patients showed HAI = 3, 10 HAI = 2, 23 HAI = 1 and 17 HAI = 0; 4 patients were lost at follow-up. In the following year, one patient dropped out. Out of the 51 remaining patients, the need of steroids in the following year was: 1 patient (5.88%) of the HH group, 6 patients (27.27%) with HAI score 1, and 9 patients (75%) of the HAI score 2/3. The difference was significant amongst all groups (p = 0.0001).

Conclusion

Maintenance treatment with high doses of 5ASA in patients with steroid-free remission determines HH in 30.3% of the patients. Patients with HH have a favourable clinical course in the following year.