Relapse In Ulcerative Colitis Patients Research Articles

Efficacy and safety of probiotics in IBD: An overview of systematic reviews and updated meta-analysis of randomized controlled trials.

Probiotics show promise in inflammatory bowel disease (IBD), yet knowledge gaps persist. We performed an overview of systematic reviews and an updated metanalysis of randomized controlled trials (RCT) assessing the effect of probiotics on Crohn's disease (CD) and ulcerative colitis (UC). MEDLINE, Web of Science, and the Cochrane Central Register of Controlled Trials were searched up to September 2023. Primary outcomes were clinical remission and recurrence; secondary outcomes included endoscopic response and remission, and adverse events. We calculated odds ratios (OR) using a random-effects model in R. The quality of systematic reviews was assessed using the AMSTAR-2; the trials' risk of bias was evaluated using the Cochrane Collaboration tool. Evidence certainty was rated using the GRADE framework. Out of 2613 results, 67 studies (22 systematic reviews and 45 RCTs) met the eligibility criteria. In the updated meta-analysis, the OR for clinical remission in UC and CD was 2.00 (95% CI 1.28-3.11) and 1.61 (95% CI 0.21-12.50), respectively. The subgroup analysis suggested that combining 5-ASA and probiotics may be beneficial for inducing remission in mild-to-moderate UC (OR 2.35, 95% CI 1.29-4.28). Probiotics decreased the odds of recurrence in relapsing pouchitis (OR 0.03, 95% CI 0.00-0.25) and trended toward reducing clinical recurrence in inactive UC (OR 0.65, 95% CI 0.42-1.01). No protective effect against recurrence was identified for CD. Multi-strain formulations appear superior in achieving remission and preventing recurrence in UC. The use of probiotics was not associated with better endoscopic outcomes. Adverse events were similar to control. However, the overall certainty of evidence was low. Probiotics, particularly multi-strain formulations, appear efficacious for the induction of clinical remission and the prevention of relapse in UC patients as well as for relapsing pouchitis. Notwithstanding, no significant effect was identified for CD. The favorable safety profile of probiotics was also highlighted.

Akkermansia muciniphila and Parabacteroides distasonis as prognostic markers for relapse in ulcerative colitis patients.

Ulcerative colitis is an inflammatory disorder characterized by chronic inflammation in the gastrointestinal tract, mainly in the colon and rectum. Although the precise etiology of ulcerative colitis remains unclear, recent research has underscored the significant role of the microbiome in its development and progression. The aim of this study was to establish a relationship between the levels of specific gut bacterial species and disease relapse in ulcerative colitis. For this study, we recruited 105 ulcerative colitis patients in remission and collected clinical data, blood, and stool samples. Akkermansia muciniphila and Parabacteroides distasonis levels were quantified in the stool samples of ulcerative colitis patients. Binary logistic regression was applied to collected data to predict disease remission. The median time in remission in this cohort was four years. A predictive model incorporating demographic information, clinical data, and the levels of Akkermansia muciniphila and Parabacteroides distasonis was developed to understand remission patterns. Our findings revealed a negative correlation between the levels of these two microorganisms and the duration of remission. These findings highlight the importance of the gut microbiota in ulcerative colitis for disease prognosis and for personalized treatments based on microbiome interventions.

Histologic Inflammation can Predict Future Clinical Relapse in Ulcerative Colitis Patients in Endoscopic Remission.

In ulcerative colitis (UC), endoscopic improvement, defined as a Mayo Endoscopic Score (MES) of 0 or 1, is a target of treatment. The aim of our study was to evaluate the risk of clinical relapse between patients with an MES of 0 or 1 and determine if histologic activity using the Robarts Histopathologic Index (RHI) was predictive of clinical relapse. UC patients with an MES score of 0 or 1, no prior colectomy, and at least 1 year of outpatient follow-up after colonoscopy were included. Demographic, clinical characteristics, and clinical relapse were retrospectively collected. Biopsy specimens were read by a gastrointestinal pathologist. Primary outcome was defined as a composite of relapse requiring change in medical therapy, new steroid use, UC-related hospitalization, and/or colectomy. Four hundred and forty-five UC patients were identified. Ninety-five percent of patients with MES 0 were in histologic remission by the RHI whereas only 35% of patients with MES 1 were in histologic remission. Twenty-six percent of patients experienced a clinical relapse; patients with MES 1 or RHI > 3 were significantly more likely to relapse (P < .01) compared to patients with MES 0 or RHI ≤ 3. When patients were stratified into 4 groups (MES 0, RHI ≤ 3; MES 0, RHI > 3; MES 1, RHI ≤ 3; MES 1, RHI > 3) and adjusted for age and sex, RHI > 3 was predictive of relapse (P = .008). UC patients with endoscopic improvement have a high rate of clinical relapse over time. Histologic activity is a predictor of clinical relapse.

Neutrophil-to-lymphocyte ratio may predict clinical relapse in ulcerative colitis patients with mucosal healing.

Endoscopic mucosal healing (MH) is an important treatment goal for patients with ulcerative colitis (UC). The neutrophil-to-lymphocyte ratio (NLR) reflects systemic inflammation and has been reported to be a useful predictive marker for UC. This study aimed to evaluate the clinical utility of the NLR for predicting clinical relapse in UC patients with MH. We retrospectively enrolled patients with UC who underwent colonoscopy at the Osaka City University Hospital between January 2010 and December 2010, whose Mayo Endoscopic Subscore was 0 or 1. The correlation between the incidence of relapse and demographic factors, including the NLR, was analyzed. We included 129 patients in the present study. The median NLR at the time of endoscopy was 1.98, and differences in the high NLR group and the low NLR group were compared. During a median follow-up period of 46.4 months, 58 patients (45.0%) experienced relapse. The cumulative relapse-free rate was significantly higher in the low NLR group than in the high NLR group (P = 0.03, log-rank test). Multivariate analysis identified high NLR as an independent prognostic factor for clinical relapse (hazard ratio, 1.74; 95% confidence interval, 1.02-2.98; P = 0.04). NLR is a novel and useful predictor of clinical relapse in UC patients with MH, and it can potentially be a strong indicator to determine the appropriate treatment strategy and decision-making in clinical practice.

Predicting Ulcerative Colitis Relapse in Clinical Remission With Fecal Immunochemical Occult Blood Test or Prostaglandin E-Major Urinary Metabolite.

The fecal immunochemical occult blood test (FIT) and prostaglandin E-major urinary metabolite (PGE-MUM) have been reported to predict the relapse of ulcerative colitis (UC) during remission. In this study, we directly compared FIT and PGE-MUM in predicting relapse and examined the effect of disease duration on these biomarkers. Measurements of 2 biomarkers and endoscopic examination were performed in 73 patients with UC in remission. The patients were followed up for 12 months, and clinical relapse was evaluated. In addition, we divided the patients into long-term disease duration and short-term disease duration groups for analysis. Twenty-one patients (28.8%) relapsed within 12 months. FIT and PGE-MUM levels were significantly higher in the relapsed group than in the remission group. Cutoff values of FIT and PGE-MUM for predicting relapse using receiver operating characteristic analysis were 65.0 ng/mL (area under the curve [AUC]: 0.723) and 25.2 μg/g·Cr (AUC: 0.701), respectively. Patients with FIT ≥ 65.0 ng/mL and PGE-MUM ≥ 25.2 μg/g·Cr had a higher risk of clinical relapse. In the short-term disease duration group, the AUCs of FIT were larger than those of PGE-MUM using receiver operating characteristic analysis, in most instances. By contrast, the AUCs of PGE-MUM were larger than those of FIT in most cases in the long-term disease groups. FIT and PEG-MUM were highly accurate in predicting clinical relapse in UC patients with short and long disease durations in remission, respectively.

Mucosal interleukin-8 expression as a predictor of subsequent relapse in ulcerative colitis patients with Mayo endoscopic subscore 0.

Complete endoscopic mucosal healing is defined as a Mayo endoscopic subscore of 0. Some patients diagnosed with a Mayo endoscopic subscore 0 may present with subsequent clinical relapse. Here, we aimed to demonstrate mucosal cytokine profile as a predictor of clinical relapse in ulcerative colitis patients with a Mayo endoscopic subscore of 0 as a marker of mucosal healing. We conducted prospective observational pilot study to examine the relationship between mucosal cytokine expression and subsequent relapse of UC patients diagnosed with a Mayo endoscopic subscore of 0. We enrolled 55 patients, and expression of cytokines tumor necrosis factor-α, interferon γ, interleukin-1β, interleukin-2, interleukin-4, interleukin-5, interleukin-6, interleukin-7, interleukin-8, interleukin-9, interleukin-10, interleukin-12, interleukin-13, interleukin-15, interleukin-17A, interleukin-17F, interleukin-18, interleukin-21, interleukin-22, interleukin-23, interleukin-27, and interleukin-33 was measured by quantitative real-time PCR using rectal mucosa biopsy materials. Cytokine expression levels were compared between patients who relapsed between March 1, 2016, and March 30, 2020, of the study period and those who remained in remission. Ten cytokines, including interleukin-2, interleukin-4, interleukin-8, interleukin-10, interleukin-12, interleukin-15, interleukin-17A, interleukin-21, interleukin-23, and interleukin-33, were significantly elevated in patients with subsequent relapse compared with those who remained in remission. Interleukin-8 expression was the most useful predictor. In the rectal mucosa of ulcerative colitis patients with Mayo endoscopic subscore 0, levels of several cytokines were elevated in cases of subsequent relapse. Among these, interleukin-8 expression was the most useful for predicting relapse.

Clinical usefulness of linked color imaging for evaluation of endoscopic activity and prediction of relapse in ulcerative colitis.

In the treatment of ulcerative colitis (UC), accurate evaluation of UC activity is important to achieve mucosal healing. We sought to investigate the clinical utility of linked color imaging (LCI) for the evaluation of endoscopic activity and prediction of relapse in UC patients. We enrolled 72 consecutive UC patients in remission who underwent colonoscopy at our institution between September 2016 and October 2018. The relationship between the presence of redness in white light imaging (WLI) and LCI and histopathological inflammation (Geboes score: GS) at 238 biopsy sites was examined. We also assessed the presence or absence of planar redness in the entire rectum as ± and classified the patients into three groups according to the combination of WLI/LCI: A: WLI-/LCI-, B: WLI-/LCI+, and C: WLI+/LCI+. The relationship between WLI/LCI classification and relapse in 64 patients followed up for more than 12months from initial colonoscopy was assessed and compared to the Mayo endoscopic subscore (MES). A GS of 0 or 1 accounted for 89% of WLI/LCI non-redness sites, while a GS of 2 or 3 accounted for 42% of WLI non-redness/LCI redness sites. LCI findings were significantly correlated with GS. During follow-up, 10 patients in group C and four patients in group B relapsed, but none in group A. Non-relapse rates were significantly correlated with WLI/LCI classification, but not with MES. LCI is a useful modality for accurate assessment of endoscopic activity and prediction of relapse in UC by detecting mild inflammation unrecognizable by WLI.

Histologic remission does not offer additional benefit for ulcerative colitis patients in endoscopic remission.

Histologic remission in ulcerative colitis (UC) patients may be associated with positive outcomes. It is unclear whether UC patients in endoscopic remission obtain additional benefit from achieving histologic remission. To evaluate the relationship between time to relapse and histological activity among UC patients in endoscopic remission. In this retrospective study using an observational database, we identified UC patients who had achieved endoscopic remission (Mayo endoscopic subscore 0). Index colonoscopy was the first colonoscopy when endoscopic remission was achieved. Histologic activity was classified as normal, inactive or active colitis. The primary outcome was time to relapse. Secondary outcomes included reasons for relapse and the association between baseline variables and risk of relapse. A Cox proportional hazards model evaluated baseline factors and the outcome of relapse. We included 269 patients. The Kaplan-Meier survival curve showed no significant difference between the presence or absence of histologic activity and time to relapse (log rank P=0.85). There was no difference in time to clinical relapse of patients with histologically active colitis compared to inactive colitis (adjusted hazard ratio [AHR] 1.17, 95% CI 0.58-2.32, P=0.67]). 5-aminosalicylate use (AHR 0.42, 95% CI 0.21-0.82, P=0.011), pancolitis (AHR 0.32, 95% CI 0.13-0.75, P=0.008), left-sided colitis (AHR 0.46; 95% CI 0.22-0.98; P=0.044) and older age (AHR 0.96, 95% CI 0.94-0.99, P=0.002) were significantly associated with reduced time to clinical relapse. Histologic remission did not influence time to relapse in UC patients who had achieved endoscopic remission.

P628 Histological remission does not offer additional benefit for ulcerative colitis patients in endoscopic remission

Abstract Background Histologic remission appears to be associated with positive outcomes in ulcerative colitis (UC) patients. However, it is not clear whether UC patients in endoscopic remission have additional benefit from achieving histologic remission. The objective of the study was to assess the relationship between time to relapse and histological activity among UC patients who are in endoscopic remission. Methods This was a retrospective observational study conducted at McMaster University Medical Centre in Hamilton, ON, Canada and University of Chicago Hospital, Chicago, IL. UC patients from an ongoing observational database who had achieved endoscopic remission (Mayo score 0) were included. Index colonoscopy was the first colonoscopy where Mayo 0 was achieved. These patients were classified based on their histologic activity: normal (no architectural changes or evidence of UC), inactive colitis (architectural changes but absence of acute inflammation), or active colitis (neutrophils in epithelium, crypt destruction, and/or erosions/ulcers). The primary outcome was time to relapse (defined as symptomatic flare with escalation of medical therapy, UC-related hospitalisation, colectomy, or development of colorectal cancer/dysplasia). Secondary outcomes included reasons for relapse and the association between other baseline variables and risk of relapse. A Cox proportional hazards model was used to evaluate the association of baseline factors with the outcome of relapse. Results 269 patients with UC and endoscopic remission were included in this study. According to a Kaplan–Meier survival curve analysis, there was no significant difference based on histologic activity with regards to time to relapse (log-rank p = 0.96)(See Figure). Patients with active colitis on histology did not have a higher relapse rate compared with those with inactive colitis (hazard ratio 1.11, p = 0.77), after adjustment for covariates. Older age, 5-aminosalicylate use, and disease location (both left-sided and pan-colitis) were found to be significantly associated with a lower rate of relapse. Symptomatic flare with an escalation of medical therapy accounted for the majority of relapses (80.4%). Conclusion Histologic remission did not impact time to relapse in UC patients who had achieved endoscopic remission. This suggests against targeting histologic remission in patients who have achieved endoscopic remission.

Reply to critique of "A randomized trial of the effects of the no-carrageenan diet on ulcerative colitis disease activity".

This article is an invited response to a critique by industry of our published study about the impact of carrageenan supplement on the interval to relapse in ulcerative colitis patients on a no-carrageenan diet.

P013 Fecal calprotectin predicts relapse in UC patients with histological remission

BACKGROUND: Histological remission has been recognized as the treatment goal of ulcerative colitis (UC). We aim to investigate the factors that predict relapse in UC patients with histological remission. METHODS: We performed a prospective study of patients with UC from March 2014 to February 2016. If patients have mucosal healing during endoscopy, several biopsy specimens were collected from sigmoid colon and rectum. An expert pathologist evaluated colonic biopsies for histological activity (Geboes score). Histological remission was defined as a Geboes score &lt;3.1. Demographic data, serological data including hemoglobin, hematocrit, white blood cell and platelet counts, albumin, C-reactive protein, and fecal calprotectin (FC) within a week of endoscopy were collected. RESULTS: Of the 36 patients in histological remission, 9/36 (25%) relapsed after a median follow-up of 29 months (range 2-45 months). FC was significantly higher in patients who relapsed compared with patients who maintained clinical remission (153.7 μg/g vs 103.4 μg/g; p = 0.047). In multivariate analysis, the FC was only independent predictors of relapse. A receiver operating characteristic analysis estimated a cutoff level of &gt;134.6 μg/g for FC (area under the curve, 0.758 and confidence interval 95%, 0.579–0.937) for predicting relapse during follow-up with 77.8% sensitivity, 74.1% specificity. CONCLUSION(S): High FC levels can predict relapse in patients with UC. Therefore, regular measurement of FC should be considered in UC patients, even if they have histological remission.

An Elevated Platelet Count Increases the Risk of Relapse in Ulcerative Colitis Patients with Mucosal Healing.

Background/AimsAlthough mucosal healing (MH) has been considered a treatment goal for patients with ulcerative colitis (UC), the risk factors predictive of relapse in patients who achieve MH are unknown. Because the platelet count has been shown to be a marker of inflammation in inflammatory bowel diseases, this study aimed to assess whether the platelet count could predict relapse in UC patients with MH.MethodsA prospective observational study was performed. UC patients with MH were consecutively enrolled in the study and monitored for at least 2 years or until relapse. The correlation between the incidence of relapse and the platelet count at the time of study enrollment was examined.ResultsIn total, 43 patients were enrolled, and 14 patients (33%) relapsed. The median platelet count at the time of enrollment in the patients who relapsed significantly differed from that in the patients who did not relapse (27.2×104/μL vs 23.8×104/μL, respectively; p=0.016). A platelet count >25.0×104/μL was a significant risk factor for relapse based on a multivariate analysis (hazard ratio, 4.85; 95% confidence interval, 1.07 to 25.28), and according to the Kaplan-Meier analysis, this cutoff could identify patients susceptible to relapse (p=0.041, log-rank test).ConclusionsThe platelet count could be used as a predictor of relapse in UC patients with MH.

Does Medical Acceleration Improve Outcomes in Ulcerative Colitis Patients Who Are in Clinical Remission but Have Endoscopic Inflammation?

Discrepancies between clinical symptoms and mucosal inflammation have been reported in up to 50% of patients with ulcerative colitis (UC). However, there are no guidelines and only limited information for appropriate treatment manipulation. We aimed to evaluate long-term outcomes according to treatment strategies and determine predictive factors for disease relapse in UC patients who are in clinical remission (CR) but still have endoscopic inflammation. A total of 204 patients who were confirmed as achieving CR but still had mucosal inflammation were included. CR was defined as "partial Mayo score ≤ 1" with no changes in medications or use of any corticosteroids during the past 3months. An active mucosal lesion was defined as "endoscopic Mayo subscore > 0." The mean patient age was 43.5years, and 53.9% were male. The mean disease duration was 89.9months. During a mean follow-up of 34months, 90 patients (44%) experienced disease relapse. The cumulative relapse-free rate did not differ by treatment strategy (maintenance of current therapy vs. dose elevation or step-up therapy). Multivariate analysis revealed that left-side colitis or pancolitis at diagnosis (OR 2.10; 95% CI 1.04-4.27; P = 0.040) and number of extraintestinal manifestations ≥ 2 (OR 5.62; 95% CI 1.10-28.68; P = 0.038) were independent predictive factors for disease relapse. The current medical acceleration treatment strategy did not have a significant influence on the long-term outcomes of UC patients in CR but with active mucosal inflammation. Disease extent at diagnosis and extraintestinal manifestations were independently predictive of disease relapse.

Prognostic value of histological activity in patients with ulcerative colitis in deep remission: A prospective multicenter study.

Histological remission has been proposed as a new treatment goal in patients with ulcerative colitis (UC) although no universal definition for microscopic activity exists. We evaluated the accuracy of histological activity to predict clinical relapse in UC patients with both clinical and endoscopic remission. Asymptomatic UC patients in endoscopic remission (Mayo endoscopic sub-score 0 or 1) undergoing surveillance colonoscopy in two referral hospitals were prospectively recruited. All colonic biopsies were analyzed according to the Geboes' score (GS) and the presence of basal plasmacytosis (BP). Ninety-six patients were included (38% women, median (interquartile range) age 50.0 (39.0-58.5) years, median disease duration 12.0 (6.5-19.5) years). Histological activity defined as GS ≥ 2B.1, GS ≥ 3.1, or BP was present in, respectively, 26%, 23% and 12%. Within 12 months from index endoscopy, 23% of the patients presented with clinical relapse. In multivariate analysis, active histological disease was the only risk factor predicting clinical relapse (odds ratio (95% confidence interval) 4.29 (1.55-11.87); p = 0.005 for GS ≥ 2B.1 and 4.31 (1.52-12.21); p = 0.006 for GS ≥ 3.1). In patients with UC in clinical and endoscopic remission, histological activity is an independent risk factor for clinical relapse. Further prospective studies need to clarify whether treatment optimization is justified in this context.

Efficacy of Bifidobacterium breve Fermented Milk in Maintaining Remission of Ulcerative Colitis

BackgroundFermented milk products containing Bifidobacterium breve strain Yakult (BFM) may improve clinical status in ulcerative colitis (UC) patients.AimsTo assess efficacy of BFM in maintaining remission in Japanese patients with quiescent UC.MethodsThis double-blind study (B-FLORA) enrolled 195 patients with quiescent UC, randomized to receive one pack of BFM fermented milk per day [Bifidobacterium breve strain Yakult (10 billion bacteria) and Lactobacillus acidophilus (1 billion bacteria)] (n = 98) or matching placebo (n = 97) for 48 weeks. The primary efficacy endpoint was relapse-free survival (relapse: rectal bleeding score ≥ 2 on Sutherland disease activity index scale for 3 consecutive days and/or initiation of remission induction therapy for worsening of UC).ResultsAn interim analysis was conducted after inclusion and follow-up of one-third of patients for the first phase of the study (n = 195). Relapse-free survival was not significantly different between the BFM and placebo groups (P = 0.643; hazard ratio 1.16; 95% CI 0.63–2.14, log-rank test), nor was the incidence of relapse. Therefore, the study was discontinued for lack of efficacy. An exploratory analysis of fecal samples from a subgroup of patients revealed no effects of either study beverage on intestinal microbiota, but there was a significant decrease in Bifidobacterium species before relapse, regardless of treatment group. Three mild adverse events occurred for which a causal relationship with the study beverage could not be ruled out (placebo: abdominal bloating and stress in one patient; BFM: body odor in one patient).ConclusionsBFM had no effect on time to relapse in UC patients compared with placebo.Study RegistrationUMIN000007593.

The risk factor of clinical relapse in ulcerative colitis patients with low dose 5-aminosalicylic acid as maintenance therapy: A report from the IBD registry.

Background5-Aminosalicylic acids (5-ASA) are effective for ulcerative colitis (UC) as a maintenance therapy. It is not clear when and how to reduce a dose of 5-ASA after inducing remission. We aimed to investigate the clinical characteristics and evaluate the risk factors of relapse for UC patients receiving 5-ASA.MethodsThe medical records of prospectively registered UC patients who received oral 5-ASA as maintenance therapy between January and December 31, 2014, were investigated. The patients’ clinical characteristics in a 2-year follow-up were compared between a relapse group and a remission group.ResultsOf 527 UC patients receiving only oral 5-ASA, 390 (74.0%) maintained remission and 137 (26.0%) relapsed during the follow-up period. Multivariable analysis indicated that a shorter duration of disease remission (p < 0.001, OR: 1.24, 95% CI: 1.12–1.38) was statistically significant for each comparison between the remission and relapse groups among all the patients. Risk factors for clinical relapse were a shorter duration of disease remission (p <0.001, OR: 1.17, 95% CI: 1.04–1.33) in the high-dose 5-ASA group and a shorter duration of disease remission (p = 0.003, OR: 1.45, 95% CI: 1.13–1.89) and a history of steroid use (p = 0.048, OR: 4.73, 95% CI: 1.01–22.2) in the low-dose group.ConclusionsA dose reduction of 5-ASA might be cautiously selected in UC patients with a history of steroid use and a shorter duration of disease remission.

983 - Highly Purified Eicosapentaenoic Acid, as Free Fatty Acid, Reduces Fecal Calprotectin Levels Andprevents Clinical Relapse in Ulcerative Colitis Patients: A Double and Blind, Randomized, Placebo Controlled Trial

983 - Highly Purified Eicosapentaenoic Acid, as Free Fatty Acid, Reduces Fecal Calprotectin Levels Andprevents Clinical Relapse in Ulcerative Colitis Patients: A Double and Blind, Randomized, Placebo Controlled Trial

P388 Risk of relapse in ulcerative colitis patients in clinical remission with combination therapy (anti-TNF and azathioprine) after immunomodulator discontinuation

P388 Risk of relapse in ulcerative colitis patients in clinical remission with combination therapy (anti-TNF and azathioprine) after immunomodulator discontinuation

P293 Histological risk factors to predict clinical relapse in ulcerative colitis in mucosal healing

Background: Currently, the target of treatment for ulcerative colitis (UC) have been changing from clinical remission to include mucosal healing, and finally histological remission. We evaluated the correlation between future clinical relapse and histological findings in patients with UC who achieved mucosal healing. Methods: Patients with UC who underwent colonoscopy with biopsies and achieved mucosal healing were enrolled into a retrospective cohort. Data were collected from April 2013 to October 2016. Mucosal healing was defined as Mayo endoscopic subscores 0 or 1. Histological findings based on Japanese criteria for the diagnosis of UC, were evaluated as the presence or absence of inflammatory cell infiltration, erosion, crypt abscess, goblet cell depletion and crypt distortion. Assessment of histologic inflammation was done by two experienced pathologists. Clinical relapse was defined by the addition of medical treatment for the clinical symptoms. Multivariate analysis by Cox proportional hazards regression tests were used to generate a prediction model of clinical relapse. Results: A total of 189 UC patients were enrolled. Clinical relapse occurred in 64 patients (33.9%) during the observation period. There was no difference in the time to relapse between Mayo endoscopic subscores 0 and 1 (p=0.3613). The rate of Clinical relapse was significantly higher in patients with erosion and/or crypt distortion compared to patients without them (p=0.0244; and p=0.0178, respectively). No significant difference was observed in patients who have inflammatory cell infiltration, crypt abscess, and/or goblet cells depletion. Multivariate analysis indicated that the presence of erosion (hazard ratio, 1.910; 95% confidence interval, 1.105–3.302, p=0.02052) and crypt distortion (hazard ratio, 2.611; 95% confidence interval, 1.125–6.059, p=0.02547) significantly affect the time to relapse, respectively. Conclusions: Presence of erosion and crypt distortion are considered to be histological risk factors for future clinical relapse in UC patients in remission who achieved mucosal healing, while Mayo endoscopic subscores did not show significant predictive values for relpase.

P581 Highly purified eicosapentaenoic acid, as free fatty acid, reduces fecal calprotectin levels and prevents clinical relapse in ulcerative colitis patients: a double-blind, randomized, placebo controlled trial

P581 Highly purified eicosapentaenoic acid, as free fatty acid, reduces fecal calprotectin levels and prevents clinical relapse in ulcerative colitis patients: a double-blind, randomized, placebo controlled trial