title: Mucosal healing predicts late outcomes after the first course of corticosteroids for newly diagnosed ulcerative colitis.
abstract: OBJECTIVE
  It is uncertain whether mucosal healing after the first course of corticosteroids therapy predicts outcome in patients with ulcerative colitis (UC). We evaluated whether early clinical and endoscopic responses to this therapy are associated with late outcomes in UC.
  
  
  METHODS
  Patients with newly diagnosed UC who were prescribed corticosteroid therapy (n = 157) were followed up for 5 years. They were evaluated using clinical (Powel-Tuck [PT]) and endoscopic (Baron) indexes after 3 and 6 months, then every 6 months. Outcomes at month 3 (early response) were used to identify patients with complete (group A: PT, 0-1; Baron, 0), partial (group B: PT, 0-1; Baron, 1-3), or no response (group C: persistence of clinical and endoscopic activity). The association between early and late outcomes was assessed.
  
  
  RESULTS
  After 5 years, there were significant differences between complete and partial responders in the rates of hospitalization (25% in group A vs 48.7% in group B; P = .0152; odds ratio [OR], 2.85; 95% confidence interval [CI], 1.21-6.72), immunosuppression therapy (5% in group A vs 25.6% in group B; P = .0030; OR, 6.55; 95% CI, 1.67-25.67), colectomy (3.3% in group A vs 18.0% in group B; P = .0265; OR, 6.34; 95% CI, 1.24-32.37), and their combination (26.7% in group A vs 48.7% in group B; P = .0249; OR, 2.61; 95% CI, 1.12-6.11). After multivariate analysis, lack of mucosal healing was the only factor associated with negative outcomes at 5 years (immunosuppressors: hazard risk [HR], 10.581; 95% CI, 2.193-51.039; P = .0033; hospitalization: HR, 3.634; 95% CI, 1.556-8.485; P = .0029; colectomy: HR, 8.397; 95% CI, 1.278-55.186; P = .0268).
  
  
  CONCLUSIONS
  No mucosal healing after corticosteroid therapy is associated with a more aggressive disease course.
authors.affiliation: Department of Clinical Science, Gastroenterology Unit, "L. Sacco" University Hospital, Milan, Italy. samari1@tin.it
authors.forename: Sandro
authors.initials: S
authors.lastname: Ardizzone
authors.forename: Andrea
authors.initials: A
authors.lastname: Cassinotti
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Duca
authors.forename: Cristina
authors.initials: C
authors.lastname: Mazzali
authors.forename: Chiara
authors.initials: C
authors.lastname: Penati
authors.forename: Gianpiero
authors.initials: G
authors.lastname: Manes
authors.forename: Riccardo
authors.initials: R
authors.lastname: Marmo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Massari
authors.forename: Paola
authors.initials: P
authors.lastname: Molteni
authors.forename: Giovanni
authors.initials: G
authors.lastname: Maconi
authors.forename: Gabriele Bianchi
authors.initials: GB
authors.lastname: Porro
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000473:pathology*; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents