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P142 Ulcerative colitis: risk factors for relapse in clinical remission patients

C. Arieira*1,2,3, H. Guimarães2, F. Dias de Castro1,2,3, M. J. Moreira1,2,3, J. Cotter1,2,3

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

Background

Ulcerative colitis (UC) is a chronic inflammatory bowel disease, characterised by periods of remission and relapse. The aim of this study was to identify factors associated with a higher risk of relapse in patients in clinical remission.

Methods

Retrospective study, including UC patients in clinical remission with minimum follow-up of 2 years. Clinical relapse was defined as a need for therapeutic escalation and UC-related hospitalisation or surgery. Statistical analysis was carried out by means of t-test and chi-square (univariate analysis) and logistic regression (multi-variate analysis). A p-value < 0.05 was considered statistically significant.

Results

In total, 169 patients were included, 51.5% female. Clinical relapse was observed in 30.2% of the patients. In the univariate analysis, relapse was more frequent in patients with higher number of previous relapses (2.7 vs. 1.0; p < 0.001), younger age at diagnosis (36.6 vs. 41.2 years ;p = 0.045) and with therapeutic non-adherence (82.4% vs. 17.6%; p < 0.001). Patients who presented at clinical remission with a Mayo Endoscopic Score (MES) of 0 had a recurrence rate of 5.6%, significantly lower than the rate of 43.2% presented by the group with mild endoscopic disease activity (MES 1) and also lower than the rate of relapse of 73.3% presented by the group with moderate endoscopic disease activity (MES 2) (p < 0.001). In the multi-variate analysis, therapeutic non-adherence (HR 24.6 CI 95% 2.0–296.6; p = 0.012) and MES >0 (HR 16.6; CI 95% 2.9–94.2; p = 0.002) were the only independent risk factors associated with relapse.

Conclusion

Presented results suggest that therapeutic non-adherence and MES at clinical remission may be helpful factors in identifying patients with inactive clinical disease at a higher risk of disease relapse.