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P128 Histological activity predicts clinical relapse in patients with ulcerative colitis in endoscopic remission

L. Laterza*1, A. C. Piscaglia2, S. Bibbò1, V. Arena3, M. Brisigotti4, G. Fabbretti4, M. L. Stefanelli2, E. Gaetani1, V. Cesario2, G. Cammarota1, A. Armuzzi5, F. Scaldaferri1, A. Gasbarrini1

1Fondazione Policlinico A. Gemelli IRCCS, Internal Medicine and Gastroenterology, Rome, Italy, 2State Hospital, Gastroenterology and Endoscopy Unit, Borgo Maggiore, San Marino, 3Fondazione Policlinico A. Gemelli IRCCS, Instiute of Pathology, Rome, Italy, 4Infermi Hospital, Institute of Pathology, Rimini, Italy, 5Fondazione Policlinico A. Gemelli IRCCS, Presidio Columbus, Rome, Italy

Background

Mucosal healing (MH) is a current target in the treatment of ulcerative colitis (UC), as it reduces the risk of surgery and hospitalisation. However, some patients with MH relapse. Persistent histological lesions (HL) beyond MH could probably explain some of these cases. Our aim was to assess the presence of histological disease in patients with MH and if it is associated with clinical relapse.

Methods

We retrospectively enrolled 100 UC patients showing MH, expressed as Mayo 0 and 1 at colonoscopy, and undergone multiple biopsies during the same examination. We evaluated whether clinical relapse was reported in patients charts up to 12 months after colonoscopy.

Results

Only 2% of patients showed the absence of HL. Chronic and acute inflammatory infiltrate and basal lymphoid aggregates were the most common (89%, 65%, and 64% of patients, respectively). Twenty-seven per cent of patients showed clinical relapse (mean time for relapse 6.5 months from baseline). At the univariate analysis, an older age (OR 0.96, p = 0.028 [95% IC 0.93–0.99]) and a longer disease duration were protective factors for relapse (OR 0.9, p = 0.014 [95% IC 0.83–0.98]). Patients with higher number of HL at baseline relapsed more frequently (OR 1.25, p = 0.012 [95% IC 1.05–1.49]), similarly to patients with basal plasmacytosis (OR 4.3, p = 0.005 [95% IC 1.57–11.98]), lamina propria eosinophils (OR 2.9, p = 0.047 [95% IC 1.02–8.83]) and surface irregularity (OR 4.7, p = 0.010 [95% IC 1.45–15.22]). At the multi-variate analysis, basal plasmacytosis (OR 3.07, p = 0.045 [95% IC 1.03–9.17]) and surface irregularity (OR 4.45, p = 0.025 [95% IC 1.20–16.48]) were confirmed as risk factors, and disease duration as a protective factor (OR 0.89, p = 0.021 [95% IC 0.81–0.98]). However, basal plasmacytosis and surface irregularity were relatively infrequent lesions, as they were found in 21% and 14% of patients, respectively.

Conclusion

HL persist in the major part of patients with MH. Basal plasmacytosis and surface irregularity correlated with clinical relapse.