title: Mucosal Healing in Ulcerative Colitis--When Zero is Better.
abstract: OBJECTIVE
  Extensive evidence has underlined the importance of mucosal healing as a treatment aim for ulcerative colitis (UC). We aimed to assess differences in the incidence of clinical relapse at 12 months between UC patients with Mayo endoscopic scores (MES) 0 and 1.
  
  
  METHODS
  This retrospective study included consecutive patients in corticosteroid-free remission between 2008 and 2013 and with follow-up of at least 1 year, with MES 0 or 1 in complete colonoscopy. Clinical relapse was defined as need for induction treatment, treatment escalation, hospitalization or surgery. A p value <0.05 was considered statistically significant.
  
  
  RESULTS
  The study included 138 patients, 72 (52.2%) female, with mean age of 49 (±14) years. Inflammatory activity was classified as MES 0 in 61 (44.2%) patients and MES 1 in 77 (55.8%) patients. Clinical relapse during follow-up was significantly more frequent in patients with MES 1 than MES 0 (27.3 vs 11.5%, p = 0.022), and in the multivariate analysis MES 1 was the only factor significantly associated with an increased risk of relapse (odds ratio 2.89, 95% confidence interval 1.14-7.36, p = 0.026). This association was encountered in the subgroup of patients with left-sided/extensive colitis (29.7 vs 11.1%, p = 0.049), but not proctitis (25.0 vs 12.0%, p = 0.202).
  
  
  CONCLUSIONS
  In patients with UC in corticosteroid-free remission, particularly those with left-sided colitis or extensive colitis, MES 1 was significantly associated with a 3-fold increased risk of relapse compared with endoscopic MES 0. Our results support the use of endoscopic MES 0 as the most suitable treatment endpoint to define mucosal healing in patients with UC.
authors.affiliation: Hospital Senhora da Oliveira - Guimarães, Rua dos Cutileiros, Creixomil, 4831-044, Guimarães, Portugal pedroboalcarvalho@chaa.min-saude.pt.
authors.forename: Pedro
authors.initials: P
authors.lastname: Boal Carvalho
authors.affiliation: Hospital Senhora da Oliveira - Guimarães, Rua dos Cutileiros, Creixomil, 4831-044, Guimarães, Portugal.
authors.forename: Francisca
authors.initials: F
authors.lastname: Dias de Castro
authors.affiliation: Hospital Senhora da Oliveira - Guimarães, Rua dos Cutileiros, Creixomil, 4831-044, Guimarães, Portugal.
authors.forename: Bruno
authors.initials: B
authors.lastname: Rosa
authors.affiliation: Hospital Senhora da Oliveira - Guimarães, Rua dos Cutileiros, Creixomil, 4831-044, Guimarães, Portugal.
authors.forename: Maria João
authors.initials: MJ
authors.lastname: Moreira
authors.affiliation: Hospital Senhora da Oliveira - Guimarães, Rua dos Cutileiros, Creixomil, 4831-044, Guimarães, Portugal Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Campus Gualtar, 4710-057, Braga, Portugal ICVS/3B's, PT Government Associate Laboratory, 4710-057 Guimarães/Braga, Portugal.
authors.forename: José
authors.initials: J
authors.lastname: Cotter
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D010131:Aminosalicylic Acid / Q000008:administration & dosage; D000704:Analysis of Variance; D001688:Biological Products / Q000008:administration & dosage; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000175:diagnosis* / Q000188:drug therapy*; D003113:Colonoscopy / Q000379:methods; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007413:Intestinal Mucosa / Q000187:drug effects / Q000473:pathology*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects* / Q000502:physiology
chemical_list: D001688:Biological Products; D007166:Immunosuppressive Agents; D010131:Aminosalicylic Acid
keywords: Mayo score; Ulcerative colitis; inflammatory bowel diseases; mucosal healing