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P625 Frequency and clinical factors associated with histologic remission in patients with ulcerative colitis: a retrospective cohort study in a Latin American country

J. Yamamoto-Furusho*1, G. Sanchez-Morales2

1IBD Clinic, Instituto Nacional de Ciencias Medicas y Nutricion, Gastroenterology, Mexico, Mexico, 2Instituto Nacional de Ciencias Medicas y Nutricion, Gastroenterology, Mexico, Mexico

Background

Currently, the treatment goal in patients with ulcerative colitis (UC) is focused to reach and maintain clinical and endoscopic remission. Studies have proposed the histologic remission as a new potential treatment goal since it has been associated with favourable long-term clinical outcomes such as reduction of colorectal cancer and colectomies. No previous studies have been performed in Latin American populations. The aim of this study was to determine the frequency and identify the clinical factors associated with histologic remission in patients with UC.

Methods

This is a retrospective cohort study that evaluated 260 patients with diagnosis of UC who were recruited from January 2007 to December 2014 and followed for at least 1 year. Clinical, demographic, endoscopic, and histologic features were obtained from medical records and personal interviews. We used the Truelove and Witts, Mayo, and Riley scores for the evaluation of clinical, endoscopic and histologic activity, respectively. The demographic and clinical characteristics included were age at diagnosis, gender, familiar history of UC, smoking, years of disease evolution, disease extension, medical treatment, ANCAs, and C-reactive protein (CRP). Univariate and multivariate analysis was performed to identify factors associated with histologic remission. The SPSS software 21v programme was used for analysis. A p-value < 0.05 was considered as significant.

Results

The frequency of histologic remission according to Riley score in our population was 25.5%. In 51.9% were males, with age at diagnosis of 31.6 years. The mean of follow-up was 4.5+3.1 years. Regarding disease extension, 78.5% had pancolitis; 16.5% proctosigmoiditis; and 5% left colitis. The clinical course of UC was distributed as follows: 77% intermittent activity (< 2 relapses per year); 13.5% initial activity and then long-term remission; and 8.8% continuous activity (more than 2 relapses per year). Concerning to current medical treatment, 91.9% used 5 aminosalicylic acid; 29.2% azathioprine; 23.8% steroids; and 3.1% anti-tumour necrosis factor (TNF) therapy. The univariate and multivariate analysis showed that factors associated with histologic remission were: ANCAs positivity (p = 0.05, relative risk [RR] = 0.54, 95% CI 0.27–1.07); endoscopic remission (p = 0.001, RR = 5.06, 95% CI 2.61–9.81); treatment with steroids (p = 0.01, RR = 0.38, 95% CIp 0.16–0.90); and azathioprine (p = 0.02, RR = 0.27, 95% CI 0.10–0.73).

Conclusion

The frequency of histologic remission was 25.5% in our population and the factors associated with histologic remission in patients with UC were ANCAs positivity, endoscopic remission, as well as treatment with steroids and azathioprine.