Harris Feldman, BS1, Lauren A. George, MD1, Ameer Abutaleb, MD1, Ashley M. Hine, BS2, Samantha Zullow, MD2, Jordan E. Axelrad, MD, MPH3, David P. Hudesman, MD3, Raymond K. Cross, MD, MS4
1University of Maryland School of Medicine, Baltimore, MD; 2New York University School of Medicine, New York, NY; 3New York University Langone Health, New York, NY; 4University of Maryland Medical Center, Baltimore, MD
Introduction: Currently, endoscopic remission in ulcerative colitis (UC) is defined using the Mayo Endoscopic subscore (MES), with a score of 0 (normal mucosa) or 1 (erythema, decreased vascular pattern, mild friability) representing mucosal healing. However, it is not clear if clinical outcomes differ between patients with a MES of 0 and 1. The aim of our study was to evaluate differences in relapse rates between patients with MES of 0 and 1.
Methods: UC patients who underwent colonoscopy at 2 IBD referral centers from 2012 to 2017 were identified. Inclusion criteria consisted of patients with a MES score of 0 or 1, no prior colectomy, and outpatient follow up for a minimum of 1 year after colonoscopy. Data was collected for demographics, disease characteristics, medications, time from last disease flare and inflammatory biomarkers. The primary outcome was defined as a composite of relapse requiring change in medical therapy, new steroid use, UC-related hospitalization, and colectomy. Chi Square, Fisher’s exact and logistic regression modeling were used in statistical calculations.
Results: 446 UC patients were identified, with 228 (51%) and 218 (49%) having a MES of 0 and 1 respectively. 78% were Caucasian, 52% were female and mean age was 40 +/- 15 years. 20, 34, and 46% had proctitis, left sided colitis and extensive or pancolitis, respectively. 46% of patients were on either a 5-ASA alone or no medical therapy, while 46% were on biologics and 27% were on biologic therapy with an immune suppressant. Within 1 year from colonoscopy, 97 (22%) had a change in medical therapy and 66 (15%) were prescribed steroids. Only 8 and 4 patients were hospitalized for UC or underwent colectomy, respectively. UC patients with a MES of 1 were more likely to experience a relapse (p< 0.01) (Table 1). After adjusting for race, disease extent, and medication use, a MES of 1 was the only factor associated with an increased the risk of relapse (aOR 2.54, 1.61-4.01) (Table 2).
Discussion: Patients with mild endoscopic activity by MES were at increased risk for relapse compared to patients with no endoscopic activity. In this population of UC patients, MES score was the only variable that predicted future relapse. Future studies are needed to classify low and high risk patients with mild endoscopic activity through evaluation of novel biomarkers and histology. Gastroenterologists should consider enhanced monitoring and/or changes in medical therapy based on the presence of even mild inflammation.
Citation: Harris Feldman, BS; Lauren A. George, MD; Ameer Abutaleb, MD; Ashley M. Hine, BS; Samantha Zullow, MD; Jordan E. Axelrad, MD, MPH; David P. Hudesman, MD; Raymond K. Cross, MD, MS. P0508 - MILD ENDOSCOPIC ACTIVITY IS ASSOCIATED WITH AN INCREASED RISK OF RELAPSE IN PATIENTS WITH ULCERATIVE COLITIS. Program No. P0508. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.