Horio Ryosuke, Kato Jun, Ohta Yuki, Taida Takashi, Saito Keiko, Iwasaki Miyuki, Ozeki Yusuke, Koshibu Yushi, Shu Nobuaki, Furuya Makoto, Oyama Yuhei, Nakazawa Hayato, Mamiya Yukiyo, Goto Chihiro, Takahashi Satsuki, Kurosugi Akane, Sonoda Michiko, Kaneko Tatsuya, Akizue Naoki, Okimoto Kenichiro, Matsumura Tomoaki, Kato Naoya
Department of Gastroenterology Graduate School of Medicine, Chiba University Chiba Japan.
JGH Open. 2024 Jul 24;8(7):e70011. doi: 10.1002/jgh3.70011. eCollection 2024 Jul.
The treatment strategy for patients with ulcerative colitis (UC) in clinical remission who have not achieved mucosal healing is unclear. This study aimed to determine the risk factors of relapse in patients in clinical remission with endoscopic activity.
This retrospective, single-center study included patients with UC who underwent colonoscopy (CS) and were in clinical remission with endoscopic activity. Characteristics were compared between patients who relapsed within 2 years after CS and those who did not. A Cox proportional hazards regression model was used to identify risk factors contributing to clinical relapse. Recent worsening in bowel symptoms was defined as increase in bowel frequency and/or increase in abdominal pain within approximately 1 month based on the descriptions in the medical charts.
This study regarded 142 patients in clinical remission with an endoscopic activity of Mayo endoscopic subscore (MES) of ≥1 as eligible, and 33 (23%) patients relapsed during the observation period. Recent worsening of bowel symptoms was a significant risk factor for clinical relapse (hazard ratio [HR]: 3.02, 95% confidence interval [CI]: 1.34-6.84). This was particularly evident in patients with MES of 2 (HR: 5.16, 95% CI: 1.48-18.04), whereas no risk factors were identified in patients with MES of 1. The presence or absence of therapeutic intervention just after CS did not significantly affect clinical relapse.
Recent worsening in bowel symptoms was a significant risk factor for clinical relapse in patients with UC who were in clinical remission with endoscopic activity.
对于临床缓解但未实现黏膜愈合的溃疡性结肠炎（UC）患者，其治疗策略尚不清楚。本研究旨在确定内镜有活动表现的临床缓解期患者复发的危险因素。
本项回顾性单中心研究纳入了接受结肠镜检查（CS）且处于临床缓解但内镜有活动表现的UC患者。比较了CS后2年内复发的患者与未复发患者的特征。采用Cox比例风险回归模型来识别导致临床复发的危险因素。根据病历描述，近期肠道症状恶化定义为在大约1个月内排便次数增加和/或腹痛加剧。
本研究将142例临床缓解且Mayo内镜亚评分（MES）≥1的内镜有活动表现的患者视为符合条件，33例（23%）患者在观察期内复发。近期肠道症状恶化是临床复发的一个重要危险因素（风险比[HR]：3.02，95%置信区间[CI]：1.34 - 6.84）。这在MES为2的患者中尤为明显（HR：5.16，95% CI：1.48 - 18.04），而MES为1的患者未发现危险因素。CS后是否进行治疗干预对临床复发无显著影响。
近期肠道症状恶化是内镜有活动表现的临床缓解期UC患者临床复发的一个重要危险因素。
