title: Predictors of endoscopic inflammation in patients with ulcerative colitis in clinical remission.
abstract: BACKGROUND
  Patients with ulcerative colitis (UC) who are in clinical remission may still have underlying endoscopic inflammation, which is associated with inferior clinical outcomes. The goal of this study was to determine the prevalence of active endoscopic disease, and factors associated with it, in patients with UC who are in clinical remission.
  
  
  METHODS
  Prospective observational study in a single center. Patients with UC in clinical remission (by Simple Clinical Colitis Activity Index) were enrolled prospectively at the time of surveillance colonoscopy. Disease phenotype, endoscopic activity (Mayo subscore), and histologic score (Geboes) were recorded, and blood was drawn for peripheral blood biomarkers.
  
  
  RESULTS
  Overall, 149 patients in clinical remission were prospectively enrolled in this cohort; 81% had been in clinical remission for >6 months, and 86% were currently prescribed maintenance medications. At endoscopy, 45% of patients in clinical remission had any endoscopic inflammation (Mayo endoscopy subscore >0), and 13% had scores >1. In a multivariate model, variables independently associated with a Mayo endoscopic score >1 were remission for <6 months (P = 0.001), white blood count (P = 0.01), and C-reactive protein level (P = 0.009). A model combining these 3 variables had a sensitivity of 94% and a specificity of 73% for predicting moderate-to-severe endoscopic activity in patients in clinical remission (area under the curve, 0.86). In an unselected subgroup of patients who had peripheral blood mononuclear cell messenger RNA profiling, GATA3 messenger RNA levels were significantly higher in patients with endoscopic activity.
  
  
  CONCLUSIONS
  Duration of clinical remission, white blood count, and C-reactive protein level can predict the probability of ongoing endoscopic activity, despite clinical remission in patients with UC. These parameters could be used to identify patients who require intensification of treatment to achieve mucosal healing.
authors: Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors: Laura
authors: L
authors: Rosenberg
authors: Garrett O
authors: GO
authors: Lawlor
authors: Talia
authors: T
authors: Zenlea
authors: Jeffrey D
authors: JD
authors: Goldsmith
authors: Anne
authors: A
authors: Gifford
authors: Kenneth R
authors: KR
authors: Falchuk
authors: Jacqueline L
authors: JL
authors: Wolf
authors: Adam S
authors: AS
authors: Cheifetz
authors: Simon C
authors: SC
authors: Robson
authors: Alan C
authors: AC
authors: Moss
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000032:analysis*; D002097:C-Reactive Protein / Q000378:metabolism; D003093:Colitis, Ulcerative / Q000150:complications* / Q000473:pathology / Q000628:therapy; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D020869:Gene Expression Profiling; D006801:Humans; D007249:Inflammation / Q000175:diagnosis* / Q000209:etiology; D007963:Leukocytes, Mononuclear / Q000378:metabolism* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D020411:Oligonucleotide Array Sequence Analysis; D011379:Prognosis; D011446:Prospective Studies; D012074:Remission Induction
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein