Comparison of Bowel Movements and SIBDQ in Ulcerative Colitis Patients with and without Mucosal Scarring

Abstract

Introduction: Mucosal healing on endoscopy is becoming an endpoint for assessing disease activity and remission in UC patients. Previous studies show that achieving mucosal healing can improve QOL and prevent relapses. A major symptom burden in patients with UC is diarrhea. Chronic inflammation can cause mucosal scarring, possibly causing a non-inflammatory secretory diarrhea. We aim to understand if mucosal scarring in histologically active and inactive disease is associated with number of bowel movements or SIBDQ. Methods: This retrospective study used a database of all IBD patients undergoing surveillance colonoscopy in a single academic GI clinic between Jan 2013 and March 2015. Patients were filtered by provider, and endoscopic and histologic results were obtained when available within 60 days of a clinic encounter. Exclusion criteria were absence of endoscopy within 60 days, history of colectomy, and insufficient data of BM or SIBDQ. “Histologically inactive” (HI) was defined as Grade 0 or 1 activity. “Histologically active” (HA) was defined as Grade 2 or 3 activity. Daily number of BM and SIBDQ was reported at each clinic visit. Student's t-test compared BM and Mann-Whitney U-test compared SIBDQ in patients with scarring vs non-scarring in HA or HI disease. Mann-Whitney U-test compared median number of BM per day and SIBDQ in HA and HI disease. Chi-square test compared endoscopic activity with histologic activity. Results: Of the total 220 patients identified, 157 were excluded. 33 of 63 included patients had HA disease. No difference in BM or SIBDQ was found in scarring vs non-scarring HI patients (p=0.735 and p=0.128, respectively). No difference in BM or SIBDQ was in scarring vs non-scarring HA patients (p=0.963 and p=0.545, respectively). In HA compared to HI disease, there was increase in median BM per day (4.0 vs 2.5, p=0.039), and nonsignificant trend for a decrease in SIBDQ (median 5.0 in HA vs 5.8 in HI, p=0.075). Endoscopic activity was associated with histologic grade 2 and 3 (chi-square 31.08, p < 0.001) Conclusion: In this retrospective review of 63 patients with UC, the presence of scarring in both HI and HA was not associated with differences in BM or SIBDQ, and therefore did not affect quality of life or symptom severity. However, histologic activity did show association with BM and SIBDQ, as well as endoscopic findings, and therefore should remain an important part of disease assessment during endoscopy for UC patients.