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        Association of endoscopic and histological remission with clinical course in patients of ulcerative colitis

        Vikram Narang,Ravneet Kaur,Bhavna Garg,Ramit Mahajan,Vandana Midha,Neena Sood,Ajit Sood 대한장연구학회 2018 Intestinal Research Vol.16 No.1

        Background/Aims: The therapeutic goal for treating ulcerative colitis (UC) patients has shifted to achieving mucosal healingover the past few years. However, at present, limited data is available on the correlation between endoscopic findings andhistological remission in patients with endoscopic mucosal healing. Methods: This was a prospective observational study conducted over a period of 18 months (January 2014 to June 2015) at Dayanand Medical College and Hospital, Ludhiana, Punjab,India. Patients diagnosed with UC who had been in clinical remission (n=76) for at least 6 months were evaluated for endoscopicremission. Those in endoscopic remission (Mayo score ≤1; 46/76, 60.5%) were subjected to multiple biopsies from therectosigmoid region and histological remission, which was then defined as grade 0/1 as per the Geboes criteria. Results: Of the46 patients in endoscopic remission (age, 18−73 years; male:female=1.5:1.0), majority had E1 (proctitis) disease (21/46, 45.6%)followed by E2 (left sided colitis) (18/46, 39.1%) and E3 disease (pancolitis) (7/46, 15.2%) at baseline. Histological remissionwas noted in 67.3% (31/46) of the patients, while 32.7% (15/46) still retained the histologically active disease in the form of infiltration of the lamina propria by eosinophils and neutrophils (13/15, 86.6%), cryptitis (14/15, 93.3%), and crypt abscesses (8/15,53.3%). On follow-up, after 1 year, 87.1% (27/31) of the patients who had been in histological remission remained clinically asymptomatic, while 12.9% (4/31) had relapsed. Among the 15 histologically active patients, 46.6% (7/15) remained in clinicalremission, while 53.3% (8/15) had relapsed. Conclusions: Histological remission, rather than endoscopic remission, predictsa sustained clinical remission and allows monitoring of therapy for the subsequent disease course in patients with UC.

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