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Moderate-to-severe Endoscopic Inflammation is Frequent After Clinical Remission in Pediatric Ulcerative Colitis
Chen Sarbagili-Shabat1,2, Dror Weiner1, Joram Wardi3
1PIBD Research center, Paediatric Gastroenterology and Nutrition Unit, The E. Wolfson Medical Center, Holon.
In pediatric ulcerative colitis (UC), over half of children achieving clinical remission still show significant endoscopic inflammation, linked to lower sustained remission rates. This highlights the need for deeper assessment beyond symptoms.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Mucosal Healing in Ulcerative Colitis
Background:
- Pediatric ulcerative colitis (UC) often presents with low sustained remission rates and disease progression.
- Moderate-to-severe endoscopic activity is a known risk factor for relapse in UC patients.
- Limited prospective data exists on early mucosal healing or persistent inflammation following clinical remission in pediatric UC.
Purpose of the Study:
- To investigate the prevalence of significant endoscopic inflammation in pediatric UC patients after achieving clinical remission.
- To determine if persistent inflammation explains the high relapse rates observed in pediatric UC.
- To evaluate the association between endoscopic healing and sustained remission in pediatric ulcerative colitis.
Main Methods:
- Prospective assessment of pediatric UC patients with clinical remission (Pediatric UC Activity Index [PUCAI] <10) for mucosal healing via endoscopy.
- Endoscopic evaluation (Mayo score) conducted 3 to 5 months post-remission by blinded adult gastroenterologists using central reading.
- Retrospective assessment of sustained remission at 18 months follow-up for patients with documented mucosal healing.
Main Results:
- Of 28 children in continuous clinical remission, 50% exhibited moderate-to-severe endoscopic inflammation (Mayo 2-3) 3-5 months after remission.
- Patients with Mayo scores of 0-1 demonstrated higher sustained remission rates (50.0%) compared to those with Mayo 2-3 (18.18%) at 18 months.
- A significant proportion of children (over 50%) with clinical remission had persistent endoscopic disease activity.
Conclusions:
- Persistent moderate-to-severe endoscopic inflammation is common in pediatric UC patients achieving clinical remission.
- Endoscopic disease activity, even after clinical remission, is associated with significantly lower rates of sustained remission.
- These findings underscore the importance of endoscopic assessment for evaluating treatment response and predicting long-term outcomes in pediatric ulcerative colitis.
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