Relapse Of Ulcerative Colitis Research Articles

Topic highlight on texture and color enhancement imaging in gastrointestinal diseases

Olympus Corporation developed texture and color enhancement imaging (TXI) as a novel image-enhancing endoscopic technique. This topic highlights a series of hot-topic articles that investigated the efficacy of TXI for gastrointestinal disease identification in the clinical setting. A randomized controlled trial demonstrated improvements in the colorectal adenoma detection rate (ADR) and the mean number of adenomas per procedure (MAP) of TXI compared with those of white-light imaging (WLI) observation (58.7% vs 42.7%, adjusted relative risk 1.35, 95%CI: 1.17-1.56; 1.36 vs 0.89, adjusted incident risk ratio 1.48, 95%CI: 1.22-1.80, respectively). A cross-over study also showed that the colorectal MAP and ADR in TXI were higher than those in WLI (1.5 vs 1.0, adjusted odds ratio 1.4, 95%CI: 1.2-1.6; 58.2% vs 46.8%, 1.5, 1.0-2.3, respectively). A randomized controlled trial demonstrated non-inferiority of TXI to narrow-band imaging in the colorectal mean number of adenomas and sessile serrated lesions per procedure (0.29 vs 0.30, difference for non-inferiority -0.01, 95%CI: -0.10 to 0.08). A cohort study found that scoring for ulcerative colitis severity using TXI could predict relapse of ulcerative colitis. A cross-sectional study found that TXI improved the gastric cancer detection rate compared to WLI (0.71% vs 0.29%). A cross-sectional study revealed that the sensitivity and accuracy for active Helicobacter pylori gastritis in TXI were higher than those of WLI (69.2% vs 52.5% and 85.3% vs 78.7%, respectively). In conclusion, TXI can improve gastrointestinal lesion detection and qualitative diagnosis. Therefore, further studies on the efficacy of TXI in clinical practice are required.

Clinical statistical analysis plan for the ACCURE trial: the effect of appendectomy on the clinical course of ulcerative colitis, a randomised international multicentre trial

BackgroundThe primary treatment of ulcerative colitis (UC) is medical therapy using a standard step-up approach. An appendectomy might modulate the clinical course of UC, decreasing the incidence of relapses and reducing need for medication. The objective of the ACCURE trial is to assess the efficacy of laparoscopic appendectomy in addition to standard medical treatment in maintaining remission in UC patients. This article presents the statistical analysis plan to evaluate the outcomes of the ACCURE trial.Design and methodsThe ACCURE trial was designed as a multicentre, randomised controlled trial. UC patients with a new diagnosis or a disease relapse within the past 12 months, treated with 5-ASA, corticosteroids, or immunomodulators until complete clinical and endoscopic remission (defined as total Mayo score < 3 with endoscopic subscore of 0 or 1), were counselled for inclusion. Also, patients previously treated with biologicals who had a washout period of at least 3 months were considered for inclusion. Patients were randomised (1:1) to laparoscopic appendectomy plus maintenance treatment or a control group (maintenance therapy only). The primary outcome is the 1-year UC relapse rate (defined as a total Mayo-score ≥ 5 with endoscopic subscore of 2 or 3, or clinically as an exacerbation of symptoms and rectal bleeding or FCP > 150 or intensified medical therapy other than 5-ASA therapy). Secondary outcomes include number of relapses per patient, time to first relapse, disease activity, number of colectomies, medication usage, and health-related quality of life.DiscussionThe ACCURE trial will provide comprehensive evidence whether adding an appendectomy to maintenance treatment is superior to maintenance treatment only in maintaining remission in UC patients.Trial registrationDutch Trial Register (NTR) NTR2883. Registered May 3, 2011. ISRCTN, ISRCTN60945764. Registered August 12, 2019.

Clinical outcomes of patients with remitting ulcerative colitis after discontinuation of indigo naturalis

Indigo naturalis is an effective treatment for ulcerative colitis. However, long-term use of indigo naturalis causes adverse events, such as pulmonary hypertension. The natural history of patients with ulcerative colitis who discontinued indigo naturalis after induction therapy is unknown. Moreover, the clinical features of patients who relapsed within 52 weeks after the discontinuation of indigo naturalis are unclear. This study aimed to assess the clinical outcomes of patients with ulcerative colitis after discontinuation of indigo naturalis and to identify potential markers responsible for relapse. This single-center retrospective study investigated the follow-up of 72 patients who achieved a clinical response 8 weeks after indigo naturalis treatment. We observed relapse in patients with ulcerative colitis after the discontinuation of indigo naturalis. We analyzed the factors predicting long-term outcomes after discontinuation of indigo naturalis. Relapse was observed in 24%, 57%, and 71% of patients at 8, 26, and 52 weeks, respectively. There were no predictive markers in patients who relapsed within 52 weeks after the discontinuation of indigo naturalis. The ulcerative colitis relapse rate after indigo naturalis discontinuation was high. Follow-up treatment is required after the discontinuation of indigo naturalis in patients with ulcerative colitis.

Predictors and Etiologies of Clinical Relapse Among Patients With Ulcerative Colitis in Deep Remission.

The objective of this study was to evaluate for potential predictors and etiologies of clinical relapse among patients with ulcerative colitis in deep remission. Patients displaying deep (endoscopic and histologic) remission have a decreased cumulative risk of relapse in ulcerative colitis of <10% per year, but predictors and etiologies of relapse in this population are poorly understood. We performed a retrospective cohort study utilizing electronic medical records at Tufts Medical Center to identify patients in deep remission, classified as having both endoscopic remission (Mayo Endoscopic Score of 0 or 1) and histologic remission (Simplified Geboes Score 0.2). We evaluated the cumulative risk of clinical relapse following attainment of deep remission and examined predictors and etiologies of relapse. Among 139 patients with ulcerative colitis in deep remission, the cumulative risk of relapse was <10% and <20% at 1 and 2 years. Patients with complete normalization of mucosa (Geboes=0) and normalization of C-reactive protein (<7.48mg/dL) at the time of remission were associated with a lower risk of relapse. Discontinuation of therapy was the most commonly identified etiology of relapse. Patients in deep remission have a 1-year risk of clinical relapse of <10%, with those demonstrating a non-normalized mucosa or elevated C-reactive protein predictive of persistent relapse risk. Discontinuation of therapy or minor histologic changes may drive relapse among those in deep remission.

ECCO Grant Untangling the gut phagosome dynamics of the relapse/remission cycle in ulcerative colitis

Abstract Background and Aims The course of ulcerative colitis (UC) is usually characterized by intertwining periods of remission and relapse. Most microbiome UC studies focus on the gut bacteriome. However, recent studies on animal models suggest that phage-mediated bacterial cell lysis may play a role in sustaining gut inflammation, proving the phageome (collection of bacteriophages) should not be ignored in this disease. Therefore, this project aims to: 1) characterize the gut phageome of patients with UC who suffer from frequent relapses, 2) compare temporal dynamics of gut the phageome between patients and healthy controls, 3) To model interactions between bacteriome, mycobiome, phageome on one hand, and lifestyle factors (diet, stress levels, medication) on the other 4) To infer host status (relapse versus remission of the disease) based on phageome composition, and using interactions inferred in Objective 3. Methods The cohort comprises 24 patients with UC (14 of whom suffered from relapse) and 10 healthy controls, with stool samples collected monthly for a year. Phageome profiling will be achieved via shotgun sequencing of phage genomes from the same stool samples. This dataset will be interrogated together with bacterial (16S rRNA) and fungal (ITS) amplicon data, which have just been generated. Available metadata include disease symptoms, diet, stress levels, work productivity, medication, and faecal calprotectin. Dynamic time-wrapping algorithms will be used to align time series of microbial members with similar temporal dynamics. Dynamic Bayesian Network modelling will infer interactions between microbiome members and predict future relapse. Anticipated Impact The phageome is the often neglected (“dark matter”) part of the microbiome, but has defining interactions with bacteria. We will expand knowledge on inter-species dynamics during relapse and remission cycles of UC. This will potentially lead to new microbiome-related relapse predictors, which may contribute to new prognostic tools in UC, and potentially inform therapeutic avenues.

P955 The effect of appendicectomy on the clinical course of Ulcerative Colitis: Preliminary results

Abstract Background Emerging evidence indicates an immunomodulatory role of the appendix in ulcerative colitis (UC). Previous studies have suggested a beneficial effect of appendicectomy in inducing and maintaining remission. Therefore, appendicectomy may be considered as an alternative or adjunctive treatment in UC. Aim To evaluate the efficacy of appendicectomy in maintaining remission in UC patients. Methods Adult patients with established UC in complete clinical and endoscopic remission (defined as Mayo score &amp;lt;3 with endoscopic subscore of 0 or 1) following medical induction treatment for disease relapse within 12 months prior to randomisation, were enrolled in the Netherlands and United Kingdom. Patients were randomised (1:1) to undergo appendicectomy (intervention group) or continue maintenance medical therapy (control group). The primary outcome was the one-year UC relapse rate (defined as a total Mayo-score score ≥5 with endoscopic subscore of ≥2). To detect a clinically relevant decrease in relapse rate from 40% to 20%, 82 patients per study arm were needed to achieve 80% power. The last patient was included in September 2022, so analysis of the primary outcome parameter is expected to start soon. Trial progress, including the accumulated number of (serious) adverse events (SAE) in both groups, were presented annually to the Data Safety Monitoring Board. Therefore safety data is available. Results In total, 99 patients were included in the intervention group and 99 patients in the control group. There were 86 males and 112 females, with a median age of 41 years (IQR 33-52). Baseline characteristics were comparable in both groups, with the majority of patients having proctitis (38.9%) or left sided colitis (35.9%). Three SAEs were reported in the appendicectomy group, 2 of which were related to the surgical procedure (reintervention for obstructive ileus and postoperative hematoma) and one hospitalisation for clostridium infection. One SAE was reported within the first year in the control group (appendicitis). The one-year reported colitis-associated adverse event rate was significantly lower in the appendicectomy group when compared to the control group (46.4% vs. 63.9%, P=0.02). During follow up there were no colectomies in the appendicectomy group, whereas three patients underwent colectomy for therapy-refractory disease in the control group. Conclusion Appendicectomy in patients with UC has the possibility to decrease the rate of colitis-associated (serious) adverse events. These results suggest that the final analysis of the primary outcome parameter (relapse rate) could demonstrate that appendicectomy is superior to standard medical therapy alone in maintaining remission in these patients.

Ustekinumab as first line therapeutic choice of biological therapy in bionaive patient affected with ulcerative colitis and intestinal reactivation of cytomegalovirus infection

Ulcerative colitis is a chronic autoimmune disease characterized by inflammation of colonic mucous layer. Patients affected with ulcerative colitis are often subjected to immunosuppressive therapy that makes them susceptible to opportunistic infections. This article presents clinical case of moderate-to-severe ulcerative colitis, complicated by cytomegalovirus infection. We demonstrated the necessity of the inclusion of cytomegalovirus infection into the differential diagnostic algorithm of ulcerative colitis relapse using molecular methods of diagnosis. Also, we justified the choice of specific antiviral therapy and first line biological therapy in a bionaive steroid-dependent, refractory to thiopurines patient. The choice of ustekinumab as therapeutic armamentarium showed to be safe and effective in attainment and maintenance of persistent clinical, laboratory and endoscopic remission in a patient affected with ulcerative colitis with intestinal reactivation of cytomegalovirus infection.

Cytokine and chemokine profiles in ulcerative colitis relapse after coronavirus disease 2019 vaccination.

Coronavirus disease 2019 (COVID-19) vaccines are highly effective; however, vaccine-related adverse events, including autoimmunity, have been reported. Case reports describing relapse or new-onset of ulcerative colitis (UC) after COVID-19 mRNA vaccination are available. However, the molecular mechanisms underlying the development of colonic inflammation associated with COVID-19 mRNA vaccination are poorly understood. Furthermore, it is unclear whether the relapse of UC after COVID-19 vaccination is driven by unique cytokine responses that differ from those of UC not associated with vaccination. mRNAs derived from COVID-19 vaccines are potent inducers of type I IFN response. We encountered three cases of UC relapse after COVID-19 vaccination. mRNA expressions of IFN-α, IFN-β, IL-1β, and IL-12/23p40 showed higher tendency in the colonic mucosa of patients with UC associated with vaccination compared with those not associated with vaccination. In contrast, the expressions of C-X-C motif chemokine ligand 9 (CXCL9) and CXCL10 were comparable. Immunofluorescence analyses also showed higher expression of IFN-α in the colonic mucosa of patients with UC associated with COVID-19 vaccination than in those not associated with vaccination. Taken together, these data suggest that the colonic mucosa of patients with UC who relapsed after COVID-19 vaccination was characterized by enhanced type I IFN responses.

White Blood Cell Counts and Future Relapse in Ulcerative Colitis under Low-Dose Thiopurine Treatment in Real-World Practice: A 3-Year Japanese Multi-Center Retrospective Cohort Study

Introduction: Whether white blood cell (WBC) counts are predictors for the effectiveness of thiopurine treatment in ulcerative colitis (UC) has been inconclusive in previous studies with small sample sizes. We investigated the association between WBC counts and future relapses in UC patients in a large-scale multi-center study. Methods: This retrospective cohort study enrolled a total of 723 UC patients in remission from 33 hospitals and followed up for 3 years. Relapse was defined as a need for treatment intensification. The risk of relapse was compared among patients with the baseline WBC counts <3,000/µL (N = 31), 3,000–4,000/µL (N = 167), 4,000–5,000/µL (N = 241), and ≥5,000/µL (N = 284) using a Cox regression model analysis. Moreover, exploratory analyses were conducted to identify other factors predicting relapse. Results: During a median follow-up period of 1,095 (interquartile range, 1,032–1,119) days, relapse occurred in 17.2% (125/723). In a crude analysis, WBC counts were not associated with relapse; hazard ratios (HRs) (95% confidence interval [CI]) were 1.50 (0.74–3.06), 1.02 (0.66–1.59), and 0.67 (0.43–1.05) in WBC <3,000/µL, 3,000–4,000/µL, and 4,000–5,000/µL groups, respectively (WBC ≥5,000/µL group, as reference). Multivariable-adjusted analyses showed similar results; HRs (95% CI) were 1.21 (0.59–2.49), 1.08 (0.69–1.69), and 0.69 (0.44–1.07), in <3,000/µL, 3,000–4,000/µL, and 4,000–5,000/µL groups, respectively. In the exploratory analyses, thiopurine use <1 year and a mean corpuscular volume <90 fL were predictors for relapse. Discussion/Conclusion: WBC counts were not predictors for future relapses in patients with UC treated with thiopurine as a maintenance therapy.

Fatal pulmonary hemorrhage, pneumothorax and skin necrosis caused by IRIS to an Aspergillus flavus infection in a young patient with metamizole associated agranulocytosis

We report the case of a young female with steroid-dependent ulcerative colitis (UC) who developed a complex systemic infection with Aspergillus flavus. This occurred following a UC relapse while vacationing in the Middle East, leading to extended use of metamizole and subsequent agranulocytosis. On her return to Germany, she was hospitalized for neutropenic sepsis and later transferred to our hospital due to persistent cytopenia and suspected Hemophagocytic Lymphohistiocytosis (HLH). Despite initial stabilization with targeted treatment for pulmonary Aspergillus flavus infection, her condition rapidly deteriorated following the onset of an Immune Reconstitution Inflammatory Syndrome (IRIS), which manifested as skin necrosis and pneumothorax after the replenishment of neutrophil granulocytes. The patient eventually died from an unmanageable pulmonary hemorrhage. Microscopy of skin necroses showed a massive presence of Aspergillus flavus, but tissue culture remained negative, suggesting effective antifungal treatment yet delayed phagocytosis due to agranulocytosis. This case underscores the need to consider IRIS in immunosuppressed patients who worsen despite aggressive and appropriately targeted treatment, highlighting its potential beyond the commonly recognized context in HIV-positive patients.

Comparison of fecal calprotectin levels and endoscopic scores for predicting relapse in patients with ulcerative colitis in remission.

Although the usefulness of endoscopic scores, such as the Mayo Endoscopic Subscore (MES), Ulcerative Colitis Endoscopic Index of Severity (UCEIS), and Ulcerative Colitis Colonoscopic Index of Severity (UCCIS), and biomarkers such as fecal calprotectin (FC) for predicting relapse in ulcerative colitis (UC) has been reported, few studies have included endoscopic scores for evaluating the entire colon. To compare the usefulness of FC value and MES, UCEIS, and UCCIS for predicting relapse in patients with UC in clinical remission. In total, 75 patients with UC in clinical and endoscopic remission who visited our institution between February 2019 and March 2022 were enrolled. The diagnosis of UC was confirmed based on the clinical presentation, endoscopic findings, and histology, according to the current established criteria for UC. Fecal samples were collected the day before or after the colonoscopy for measurement of FC. Endoscopic evaluations were performed using MES, UCEIS, and UCCIS. The primary outcome measure of this study was the assessment of the association between relapse within 12 mo and MES, UCEIS, UCCIS, and FC. The secondary outcome was the comparison between endoscopic scores and biomarkers in enrolled patients with UC with mucosal healing. FC and UCCIS showed a significant correlation with UCEIS (r = 0.537, P < 0.001 and r = 0.957, P < 0.001, respectively). Receiver-operating characteristic analysis for predicting MES 0 showed that the area under the curve of UCCIS was significantly higher than that of FC (P < 0.01). During the 1-year observation period, 18 (24%) patients experienced a relapse, and both the FC and UCCIS of the relapse group were significantly higher than that of the remission group. The cut-off values for predicting relapse were set at FC = 323 mg/kg and UCCIS = 10.2. The area under the curve of the receiver-operating characteristic analysis for predicting relapse did not show a significant difference between FC and UCCIS. The accuracy of the endoscopic scores and biomarkers in predicting relapse was 86.7% for UCCIS, 85.3% for UCEIS, 76.0% for FC, and 73.3% for MES. The three endoscopic scores and FC may predict UC relapse during clinical remission. Among these scores, UCEIS may be the most useful in terms of ease of evaluation and accuracy.

2-Year Experience with Risankizumab in the Treatment of Plaque Psoriasis in Lazio Region, Italy

Background. Given the chronic relapsing, remitting course of psoriasis, data about long-term effectiveness may be useful to assess the maintenance of clinical response over time. Objective. To evaluate 2-year drug survival of risankizumab and identify any predictive factor of discontinuation for ineffectiveness. Materials and Methods. A multicenter retrospective study was conducted in patients who initiated risankizumab between July 2019 and December 2020. PASI was measured at baseline and after 104 weeks. Any adverse event was registered during visits. Univariable and multivariable logistic regressions were used to assess baseline patients’ characteristics that predicted clinical response. The drug survival analysis was descriptively performed using the Kaplan–Meier survival curve. Results. 112 patients with moderate-to-severe plaque psoriasis were included. The overall median observation time was 35.3 months (26.7–37.3); the estimated survivor cumulative function at months 12 and 24 was 93.6% and 90.6%, respectively. No differences in BMI, disease duration, disease severity, or previous biological therapies were observed in patients who responded or did not respond to treatment. No significant adverse events were reported, but there was relapse of psoriatic arthritis and ulcerative colitis in a patient. Conclusions. We found that risankizumab was associated with long-term effectiveness, and a favorable safety profile in a population of psoriatic patients was observed, over a period of 2 years.

Serological Biomarker-Based Machine Learning Models for Predicting the Relapse of Ulcerative Colitis.

To explore whether machine learning models using serological markers can predict the relapse of Ulcerative colitis (UC). This clinical cohort study included 292 UC patients, and serological markers were obtained when patients were discharged from the hospital. Subsequently, four machine learning models including the random forest (RF) model, the logistic regression model, the decision tree, and the neural network were compared to predict the relapse of UC. A nomogram was constructed, and the performance of these models was evaluated by accuracy, sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC). Based on the patients' characteristics and serological markers, we selected the relevant variables associated with relapse and developed a LR model. The novel model including gender, white blood cell count, percentage of leukomonocyte, percentage of monocyte, absolute value of neutrophilic granulocyte, and erythrocyte sedimentation rate was established for predicting the relapse. In addition, the average AUC of the four machine learning models was 0.828, of which the RF model was the best. The AUC of the test group was 0.889, the accuracy was 76.4%, the sensitivity was 78.5%, and the specificity was 76.4%. There were 45 variables in the RF models, and the relative weight coefficients of these variables were determined. Age has the greatest impact on classification results, followed by hemoglobin concentration, white blood cell count, and platelet distribution width. Machine learning models based on serological markers had high accuracy in predicting the relapse of UC. The model can be used to noninvasively predict patient outcomes and can be an effective tool for determining personalized treatment plans.

Development and Pilot Testing of an Online Calculation Tool for Relapse Risk Prediction in Ulcerative Colitis.

Background: Ulcerative colitis (UC) is a relapsing gastrointestinal disease. Identifying patients at a high risk of UC relapse and initiating preventive treatment can reduce the risk of UC recurrence and its dangerous side effects. The present study was performed to design and pilot test an online calculation tool for relapse risk prediction in UC. Methods: This study is based on our previous prospective study on 157 patients with UC in-remission UC. We designed an online website rooted in our pre-developed equation to calculate relapse risk scores. Then, 280 patients with UC who were not in relapse were randomly selected from our database, and the required information was filled in on the website accordingly. Finally, the indicators were manually calculated using the formula and compared with online-calculated data. Results: The developed bilingual website is available at http://www.ucrelapserisk.com. Of the 280 patients with UC, 151 (53.9%) were male. 88 patients were at high risk of relapse in the following year. There were no differences between the manually and online calculated Seo index, UC risk score, and probability of relapse in one year. Conclusion: This online tool is now available for patients and clinicians and provides an accurate relapse risk prediction for UC patients.

Safety of full bowel preparation and colonoscopy in elderly patients with ulcerative colitis: A real-world multicenter retrospective cohort study.

The number of elderly patients with ulcerative colitis (UC) has been increasing worldwide. Complications are common in elderly patients who undergo colonoscopy, raising doubts about whether colonoscopy should be performed in the same way in this age group as in younger patients. The aim of this study was to determine the safety of full bowel preparation and colonoscopy in elderly patients with UC. We retrospectively reviewed a cohort of patients with UC who had visited any of the 12 hospitals and were registered in our inflammatory bowel disease database. We compared complications associated with colonoscopy and bowel preparation and relapse of UC after colonoscopy in 133 patients aged ≥65 years with UC (the elderly group) and 116 randomly selected patients aged <65 years with UC (the non-elderly group). Nine elderly patients were not referred for colonoscopy by their physicians because of poor performance status or advanced age. There was no significant between-group difference in the complication rate (p = 0.57) or frequency of relapse of UC after colonoscopy (p = 0.67). The findings of this study indicate that colonoscopy can be performed as safely in elderly patients with UC as in their younger counterparts. However, our results also indicate that colonoscopy is often avoided in elderly patients, possibly because of concerns about safety.

Fecal lactoferrin early predicts long-term outcomes in ulcerative colitis: A post-hoc analysis of the UNIFI and PURSUIT trials.

Fecal lactoferrin (FL) is associated with disease activity and relapse in ulcerative colitis. However, whether FL could early predict long-term outcomes in ulcerative colitis is poorly understood. This post-hoc analysis included participants who received biologics and had available data of FL concentration at week 4 from the UNIFI and PURSUIT trials (n=1063). Therapeutic outcomes, including clinical remission, endoscopic improvement and remission, and histological improvement and remission, were evaluated at the end of maintenance therapy. The incidence of colectomy was observed from week 0 to maximum week 228 in the PURSUIT trial (n=667). Multivariate logistic and Cox proportional-hazard regression were conducted to evaluate the associations between FL and therapeutic outcomes and colectomy, respectively. A high FL level at week 4 was associated with poor long-term clinical, endoscopic and histologic outcomes. FL >84.5μg/mL predicted a low likelihood of clinical (OR [95% CI]: 0.43 [0.32, 0.57]; p<0.001), endoscopic (OR [95% CI]: 0.40 [0.29, 0.56]; p<0.001), and histological (OR [95% CI]: 0.27 [0.14, 0.53]; p<0.001) remission. Moreover, week-4 FL could add prognostic value to fecal calprotectin and clinical and endoscopic scores for informing long-term therapeutic outcomes. For the risk of colectomy, patients with week-4 FL <20.1 and ≥20.1µg/mL had an incidence rate of 1.10% and 6.39%, respectively. Patients with FL ≥20.1µg/mL had a 995% higher risk of colectomy (HR [95% CI], 10.95 [1.45, 82.74]). FL could be a promising prognostic biomarker for long-term therapeutic outcomes and risk of colectomy in patient of ulcerative colitis.

Multiple Orocutaneous Extraintestinal Manifestations in Ulcerative Colitis Patient: Complete Response to Ustekinumab.

Pyostomatitis vegetans (PV) is characterized by exophytic-erythematous pustules with superficial erosions of the oral mucosa, while pyoderma gangrenosum (PG) is a rare skin disorder characterized by the development of painful and deeply ulcerated necrotic areas.1 The diagnosis of PV and PG is based on clinical features while histology is unspecific and not always required.2 We report a case of a 73-year-old woman with steroid-dependent, long-standing pancolonic ulcerative colitis (UC) previously treated with azathioprine and naïve to biologics. She was admitted to hospital for sepsis (fever 39 °C, white blood cell count 18 000, C-reactive protein >200 mg/dL, procalcitonin 0.75 ng/mL) and moderate UC relapse (partial Mayo score 10, Mayo endoscopic subscore 1) with multiple painful, ulcerated, vegetative and purulent lesions in the oral cavity and skin (leg and sacral regions) (Figure 1). ... Intravenous (IV) piperacillin-tazobactam was started and sepsis resolved after 3 days. After dermatological assessment a diagnosis of multiple PG and oral PV was made, IV methylprednisolone 60 mg/d was started. Remission of intestinal symptoms and improvement of orocutaneous lesions were observed until steroid tapering, when orocutaneous lesions worsened. Due to the age of the patient and the recent septic event, anti-tumor necrosis factor (TNF) treatment was considered not indicated and IV ustekinumab 390 mg was started followed by a maintenance regimen with 90 mg every 8 weeks. Complete healing of the orocutaneous lesions and clinical and biochemical remission (partial Mayo score 0, C-reactive protein normalization, fecal calprotectin <150 µg/g) was obtained by the end of induction and maintained off of steroids during the following 10 months.

HISTOPATHOLOGICAL FEATURES IN RELAPSE OF ULCERATIVE COLITIS.

Background and objective: To determine the frequencies of various histopathological features of relapse in previously diagnosed cases of ulcerative colitis . Methods: This was a Cross sectional study conducted at Histopathology department of Sheikh Zayed hospital Lahore from 1/6/2014 to 1/12/2014. Two hundred and seventy colonic biopsies were assessed using 3% margin of error and 95% of the confidence level. Patients clinically relapsed with ulcerative colitis including both genders in age group from 11 to 80 years were included. Biopsy specimen fixed in 10% formalin were received. Processing was done and sections stained with hematoxylin and were examined by the pathologist. College of Physicians and Surgeons Pakistan gave approval for this study. Data was then analyzed and entered by the SPSS version15. Results: Total number of patients were 270,out of which all of the patients have shown chronic inflammation and increase number of neutrophils in lamina propria (100%), focal lymphoid aggregate in 162/270(60%), increased number of eosinophils in lamina propria in 108/270(40%), cryptitis in 216/270(80%), crypt distortion in 202/270(75%), mucin depletion in151/270 (56%) and crypt abscess formation in 148/270(55%). Conclusion: Hence, cryptitis and crypt abscess were observed to be most commonly occurring significant and reliable featuress of relapse in ulcerative colitis.

Biologická terapie ulcerózní kolitidy v graviditě

Summary: The annotated case report describes the case of a patient with ulcerative colitis (UC) who was successfully treated with infliximab at the beginning of disease due to failure of conventional therapy. For a long-term remission of UC, it was decided to end bio­logical therapy during the third trimester of pregnancy. For the relapse of UC after the delivery, the initiation of vedolizumab therapy was indicated, after which a remission of UC was achieved, and therefore VDZ maintenance treatment was continued in the following course. A new pregnancy occurred on this therapy, which developed without complications to the indicated treatment. This thesis evaluates the benefits and possible risks of bio­logical treatment during pregnancy. Key words: ulcerative colitis – pregnancy – infliximab – vedolizumab

P253 Histological Remission and Activity as Predictor of Relapse, Hospitalization, and Surgery in Ulcerative Colitis: Systematic Review and Meta-analysis

Abstract Background Treatment targets in patients with inflammatory bowel disease (IBD) have evolved over the last two decades. The significance of histological remission as a treatment target in patients with ulcerative colitis (UC) is not well established. The aim of this study is to assess risk of clinical relapse, hospitalizations and need for surgery in patients who achieved histological remission compared to patients with active histology in UC. Methods MEDLINE, EMBASE, Cochrane CENTRAL and conference abstracts were searched from inception to October 2022. Inclusion criteria included any randomized controlled trial or observational study that included adult patients with UC who achieved histological remission. The primary outcome was the risk of clinical relapse, hospitalization and need for surgery in patients with UC who achieved histological remission compared to patients with active histology. The outcomes were collected and stratified by 2 time points, 6-12 months and 13 or more months. Random effects model was used to calculate pooled risk ratio (RR) and 95% CIs and I2 statistics were used to assess heterogeneity. Results In total 28 studies were included in this meta-analysis. At 6-12 months, the risk of clinical relapse was higher in patients with active histology compared to patients who achieved histological remission (RR= 2.41, 95% confidence interval (CI) 1.69-3.44, p&amp;lt;0.01). There was no difference in risk of hospitalization in patients with histological remission compared to patients with active histology (RR= 4.22, 95% CI 0.91- 19.62, p=0.07). At 13 months or more, the risk of clinical relapse was higher in patients with active histology compared to patients who achieved histological remission (RR= 2.07, 95% CI 1.55-2.76, p&amp;lt;0.01). Risk of hospitalization and need for surgery was also higher in patients with active histology compared to patients who achieved histological remission; (RR= 2.52, 95% CI 1.59-4.00, p&amp;lt;0.01) and (RR= 3.14, 95% CI 1.53-6.45, p&amp;lt;0.01) respectively. Conclusion Histological remission in ulcerative colitis represents a treatment target that is not yet routinely sought in practice. Our study suggests that patients who achieve histological remission have better outcomes in UC than those with active histology.