Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea; Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Korea.
Turk J Gastroenterol. 2022 Aug;33(8):682-688. doi: 10.5152/tjg.2022.21375.
Endoscopy remains the gold standard for evaluating mucosal healing in ulcerative colitis. However, given its invasiveness and high cost, it is not always possible to perform it as often. This study aimed to evaluate value of numerous patient-reported symptoms in the prediction of endoscopic mucosal healing.
We prospectively conducted a cohort involving 143 patients with ulcerative colitis (men: 63.6%, median age: 40.0 years) in a tertiary teaching hospital between May 2017 and May 2020. Clinical remission was defined as resolution of rectal bleeding and normalization of stool frequency, set as basic patient-reported outcomes. The presence of additional 4 patient-reported outcomes (urgency, tenesmus, mucoid stool, and night defecation) were evaluated. Endoscopic activity was graded using the Ulcerative Colitis Endoscopic Index of Severity and endoscopic mucosal healing was defined as Ulcerative Colitis Endoscopic Index of Severity 0-1.
A total of 44 (30.77%) ulcerative colitis patients were categorized as achieving endoscopic mucosal healing. Across different patient-reported outcomes status in predicting endoscopic mucosal healing, clinical remission status inferred from basic patient-reported outcomes was superior to additional 4 patient-reported outcomes collectively (sensitivity/specificity: Ulcerative Colitis Endoscopic Index of Severity = 0/1, basic patient-reported outcomes 59.09%/75.76%, additional 4 patient-reported outcomes 70.45%/72.73%). Combination of basic and additional patient-reported outcomes revealed increased specificity of 83.84%. Multivariate analysis adjusted for age, sex, disease extent, and disease duration also revealed consistent results that patient-reported outcomes were independently associated to endoscopic mucosal healing (P < .001).
Recognizing the presence of additional patient-reported outcomes may be useful in clinical practice as it is a simple and easy method that not only reflects patient's quality of life but can also relatively better predict endoscopic mucosal healing status than basic patient-reported outcomes.
内镜检查仍然是评估溃疡性结肠炎黏膜愈合的金标准。然而，由于其侵袭性和高成本，并非总是可以经常进行。本研究旨在评估许多患者报告的症状在预测内镜黏膜愈合中的价值。
我们前瞻性地在 2017 年 5 月至 2020 年 5 月期间在一家三级教学医院对 143 例溃疡性结肠炎患者（男性：63.6%，中位年龄：40.0 岁）进行了队列研究。临床缓解定义为直肠出血消退和粪便频率正常，设为基本患者报告结局。评估了另外 4 个患者报告结局（急迫感、里急后重、黏液便和夜间排便）的存在。使用溃疡性结肠炎内镜严重指数对内镜活动进行分级，内镜黏膜愈合定义为溃疡性结肠炎内镜严重指数 0-1。
共有 44 例（30.77%）溃疡性结肠炎患者被归类为达到内镜黏膜愈合。在不同的患者报告结局状态预测内镜黏膜愈合方面，基本患者报告结局推断的临床缓解状态优于另外 4 个患者报告结局的总和（敏感性/特异性：溃疡性结肠炎内镜严重指数=0/1，基本患者报告结局 59.09%/75.76%，另外 4 个患者报告结局 70.45%/72.73%）。基本和额外患者报告结局的组合显示出 83.84%的特异性增加。调整年龄、性别、疾病范围和疾病持续时间的多变量分析也显示出患者报告的结局与内镜黏膜愈合独立相关（P<.001）。
认识到额外的患者报告结局的存在可能在临床实践中是有用的，因为它是一种简单易行的方法，不仅反映了患者的生活质量，而且与基本的患者报告结局相比，能够更好地预测内镜黏膜愈合状态。
