P138 Clinical remission in ulcerative colitis one year after diagnosis is an unreliable terminology

Abstract

Background: Medical treatment in ulcerative colitis (UC) has traditionally been guided by patient symptoms, with the main purpose to induce and maintain clinical remission. However data suggest that the use of clinical outcome measures is not adequate to accomplish long-term treatment success, and that mucosal healing should be the primary treatment goal. The aim of the present study was to compare clinical and endoscopic evaluations one year after diagnosis, in terms of evaluating the reliability of clinical symptoms as a marker of treatment in UC. Methods: A population-based cohort of 462 UC patients attending a standardised one-year follow-up visit (the IBSEN study) who had not undergone colectomy was enrolled in the present analysis. At the visit clinical and endoscopic evaluations were performed. Patients were regarded to be in clinical remission or clinically active on the basis of symptoms, i.e. rectal urgency, stool frequency and/or bleeding. Endoscopic evaluations was based on endoscopic score of 0 2 (0, normal; 1, light erythema or granularity; 2, granularity, friability, and bleeding, with or without the addition of ulcerations). Score 0 or 1 was regarded as mucosal healing and score 2 as active inflammation. Results: At the one-year visit 371 patients (81%) were in clinical remission, while 89 patients (19%) were clinically active. Endoscopic evaluation was performed in 292 and 70 of the patients who were in clinical remission and clinically active, respectively. Of the patients in clinical remission (n = 292), endoscopic healing was observed in 172 patients (59%), while signs of active inflammation were observed in 120 patients (41%). Pertaining to the group of patients who were clinically active (n = 70), endoscopy showed mucosal healing in 6 patients and signs of active inflammation in 64 patients (91%). Conclusions: Surprisingly many patients with ulcerative colitis, who were regarded to be in clinical remission one year after diagnosis judged by symptoms, had endoscopically active inflammation. This warrants that clinical evaluation of remission is insufficient if we belive that mucosal healing determines the best longterm outcome in UC.