Clinical Remission is Predictive of Endoscopic Remission and Clinical Disease Activity is Predictive of Endoscopic Disease Activity in Patients with Ulcerative Colitis at the Time of Surveillance Colonoscopy

Abstract

Purpose: It is unknown whether the majority of patients who are in clinical remission have endoscopically inactive disease. The aim of this study was to compare and contrast the clinical and endoscopic disease activity in UC patients in clinical remission and those with disease activity at the time of their surveillance colonoscopy. Methods: We performed a retrospective review of electronic medical records of all UC outpatients seen at our institution from Oct 1998 to Oct 2010 and identified those who underwent surveillance colonoscopy at our institution and whose clinical data were available to calculate clinical disease activity at the time of their colonoscopy. Clinical and endoscopic activities were assessed at the time of colonoscopy using the Simple Clinical Colitis Activity Index (SCCAI) and Froslie Endoscopic Score (FES), respectively. Clinical remission was defined as SCCAI < 2 and mucosal healing was defined as FES 0 or 1. The following variables were assessed as possible predictors using multivariate logistic regression analysis: age, sex, duration of UC, smoking status, baseline medications (5-ASA, corticosteroids (CS), thiopurines, anti-TNF agents), and SCCAI and FES. Only variables that reached p-value less than 0.20 in a model with clinical activity index or endoscopic activity index as covariates were included in a multivariable logistic regression model. Results: 184 patients met inclusion criteria with the following demographic information: mean age 45.7 yrs; 53% women; mean duration of UC 14.6 years. Among them, 82 (44.6%) patients had clinically active disease whereas 102 patients (55.4%) had clinically inactive disease. Among 82 with clinically active disease, 65 patients (79.3%) had endoscopically active disease and 17 patients (20.7%) had endoscopically inactive disease (OR= 13.13, 95% CI 6.47-26.6,p<0.0001). On the other hand, among 102 patients with clinically inactive disease, 23 patients (22.5%) had endoscopically active disease and 79 patients (77.5%) had endoscopically inactive disease (OR= 13.13, 95% CI 6.47-26.6,p<0.0001). In multivariable analysis, only corticosteroids use at the time of endoscopy was predictive of current clinical activity of the disease with an OR 5.36 (95% CI 1.98, 14.52), after adjusting for endoscopic activity. On the other hand, none of the predictors of endoscopic activity adjusted for clinical activity reached a p-value <0.20. Conclusion: Patients with clinically active UC are 13 times more likely to have endoscopically active disease than those with clinically inactive disease at the time of their surveillance colonoscopy. Treatment with CS is an independent predictor of persistent clinical disease activity in patients with UC. Disclosure: Gary R. Lichtenstein, MD POTENTIAL CONFLICT OF INTEREST DECLARATION Abbott Corporation Consultant Alaven Consultant, Research Bristol-Myers Squibb Research Centocor Orthobiotech Consultant, Research Elan Consultant Ferring Consultant, Research Meda Pharmaceuticals Consultant Millenium Pharmaceuticals Consultant Pfizer Pharmaceuticals Consultant Proctor and Gamble Consultant, Research Prometheus Laboratories, Inc. Consultant, Research Salix Pharmaceuticals Consultant, Research Santarus Consultant Schering-Plough Corporation Consultant Shire Pharmaceuticals Consultant, Research UCB Consultant, Research Warner Chilcotte Consultant, Research Wyeth Consultant.