Factors associated with mucosal healing in patients with ulcerative colitis in clinical remission.
BACKGROUND
Mucosal healing (MH) has been associated with improved outcomes in ulcerative colitis but factors associated with MH are not well defined.


METHODS
Consecutive patients with ulcerative colitis in clinical remission (Mayo symptomatic subscore = 0) who had at least 1 colonoscopy since diagnosis from 6 centers were included. For patients who had at least 2 colonoscopies during follow-up, each colonoscopy was reviewed to define whether they had early MH (Mayo endoscopic subscore reduced to 0 within 3 yr of clinical remission). Factors associated with MH and early MH were determined using logistic regression.


RESULTS
Two hundred thirty-seven patients with ulcerative colitis (mean age 50.39 ± 14.10 yr; 56.5% male) were included. Independent factors for MH were clinical remission >3 years (odds ratio [OR] 4.0; 95% confidence interval [CI], 1.2-13.1), mild/moderate mucosal inflammation (OR 3.3; 95% CI, 1.3-8.5), and immunosuppressant use (OR 4.6; 95% CI, 1.5-14.6). Among patients who had ≥2 of above factors, 74% achieved MH, whereas only 39% with <2 factors achieved MH (P < 0.001). Of patients in clinical remission <1 year, 1 to 3 years and >3 years, 30%, 45.9%, and 62.9% achieved MH, respectively. Immunosuppressant therapy was associated with early MH (P = 0.025). In multivariate analysis, patients with previous mild inflammation were more likely to achieve early MH than those with moderate/severe inflammation (OR 2.8; 95% CI, 1.2-6.2).


CONCLUSIONS
A longer disease remission, previous less severe mucosal inflammation, and immunosuppressant use are associated with MH. Severity of mucosal inflammation and use of immunosuppressant are also associated with early MH.
*Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China; †Department of Medicine, Tseung Kwan O Hospital, Hong Kong, China; ‡Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China; §Department of Medicine, The University of Hong Kong, Hong Kong, China; ||Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, China; ¶Department of Medicine and Geriatrics, Caritas Medical Center, Hong Kong, China; and **Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, China.
Hai Yun
HY
Shi
Francis K L
FK
Chan
Steven W C
SW
Tsang
Yee Tak
YT
Hui
Shun Fung
SF
Sze
Jessica Y L
JY
Ching
Tiffany
T
Chung
Catherine Y Y
CY
Iu
Fu Hang
FH
Lo
Edwin H S
EH
Shan
Michael K K
MK
Li
Justin C Y
JC
Wu
Joseph J Y
JJ
Sung
Siew C
SC
Ng
D000293:Adolescent; D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000473:pathology*; D003113:Colonoscopy; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007249:Inflammation / Q000473:pathology; D007413:Intestinal Mucosa / Q000473:pathology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012075:Remission, Spontaneous
D007166:Immunosuppressive Agents