[Evaluation of endoscopic and histological activity as predictors of clinical relapse in ulcerative colitis]
Juan Eloy Paredes Méndez1, Paulo Anibal Alosilla Sandoval1, Wilmer Gustavo Quiroga Purizaca1
1Servicio de Gastroenterología, Hospital Nacional Guillermo Almenara Irigoyen. Lima, Per ú.
Abstract:
Ulcerative colitis is a chronic inflammatory disease characterized by a recurrent and remitting course. Clinical remission and mucosal healing are the current therapeutic goals in management. The histological remission could be a better objective because of its prognostic impact.
Objective:
To evaluate endoscopic and histological activity as predictors of clinical relapse in patients with ulcerative colitis.
Materials And Methods:
Prospective descriptive study conducted from January 2015 to June 2018 at Guillermo Almenara Irigoyen National Hospital. Thirty-three patients diagnosed with ulcerative colitis who presented clinical remission after a flare were evaluated. Endoscopic remission was assessed (Mayo Score ≤1) after 6 months of follow- up with ileocolonoscopy and rectosigmoid biopsies. Histological remission was defined as score < 2 in the Simplified Geboes Score (SGS). Follow-up was performed for one year to observe relapses.
Results:
26 (78.8%) patients achieved endoscopic remission at 6 months (mean age 53 years, males 57.7%). Histological remission was observed in 69.2% (18/26). After 1 year of follow-up, 83.3% (15/18) of the patients who presented clinical, endoscopic and histological remission remained clinically asymptomatic. The RR of clinical relapse at one year was 3,18 (95% IC, 1,58-6,42, p=0,004) in patients without endoscopic remission and 4 (95% IC, 1,34-11,94, p=0,003) in patients without histological remission.
Conclusions:
Histological activity could be a better predictor of relapse compared to endoscopic remission, and should be the final therapeutic objective in the management of patients with ulcerative colitis.
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