- Original article
- Open access
- Published:
Evaluation of false remission in ulcerative colitis and the need for a revised disease activity index
The Egyptian Journal of Internal Medicine volume 26, pages 151–156 (2014)
Abstract
Aim of the work
To highlight some criteria of remission in ulcerative colitis, to address the issue of false remission, and settle a standard index for its detection.
Patients and methods
Patients with ulcerative colitis in clinical remission were enrolled prospectively and followed for 1 year for evaluation of clinical manifestations, C-reactive protein, fecal calprotectin, and tumor necrosis factor-α, and colonoscopic and microscopic examination for the detection of actual remission, with the exclusion of those who developed clinical relapse during the study.
Results
Out of 36 patients, we had 11 patients (30.5%) with true remission and 25 patients (69.5%) with false remission: 19 patients (52.7%) in false remission group A with abnormal mucosal healing and six patients (16%) in false remission group B with high inflammatory markers. There was a significant positive correlation of inflammatory markers with the ulcerative colitis disease activity index in patients with true remission. There was a significant correlation of the ulcerative colitis disease activity index and histological grades in false remission A and a significant correlation of inflammatory markers with histological grades in false remission B.
Conclusion
About 70% of our patients with ulcerative colitis in clinical remission had an active disease. Clinical remission in ulcerative colitis can be best expressed as true and false remission depending on histological grading in a revised ulcerative colitis disease activity index. Some inflammatory markers can be useful for the detection of true remission.
References
Peyrin-Biroulet L, Loftus EV Jr, Colombel JF, Sandborn WJ. The natural history of adult Crohn’s disease in population-based cohorts. Am J Gastroenterol 2010; 105:289–297.
Langholz E. Ulcerative colitis. An epidemiological study based on a regional inception cohort, with special reference to disease course and prognosis. Dan Med Bull 1999; 46:400–415.
Meucci G, Fasoli R, Saibeni S, Valpiani D, Gullotta R, Colombo E, et al. IG-IBD Prognostic significance of endoscopic remission in patients with active ulcerative colitis treated with oral and topical mesalazine: a prospective, multicenter study. Inflamm Bowel Dis 2012; 18:1006–1010.
Colombel JF, Rutgeerts P, Reinisch W, Esser D, Wang Y, Lang Y, et al. Early mucosal healing with infliximab is associated with improved long-term clinical outcomes in ulcerative colitis. Gastroenterology 2011; 141:1194–1201.
Rutgeerts P, Vermeire S, Van Assche G. Mucosal healing in inflammatory bowel disease: impossible ideal or therapeutic target?. Gut 2007; 56:453–455.
Dave M, Loftus EV Jr. Mucosal healing in inflammatory bowel disease-a true paradigm of success?. Gastroenterol Hepatol (N Y) 2012; 8:29–38.
Sipponen T, Savilahti E, Kärkkäinen P, Kolho KL, Nuutinen H, Turunen U, Färkkilä M. Fecal calprotectin, lactoferrin, and endoscopic disease activity in monitoring anti-TNF-alpha therapy for Crohn’s disease. Inflamm Bowel Dis 2008; 14:1392–1398.
Peyrin-Biroulet L, Ferrante M, Magro F, Campbell S, Franchimont D, Fidder H, et al. Scientific Committee of the European Crohn’s and Colitis Organization Results from the 2nd Scientific Workshop of the ECCO. I: impact of mucosal healing on the course of inflammatory bowel disease. J Crohns Colitis 2011; 5:477–483.
Sutherland LR, Martin F, Greer S, Robinson M, Greenberger N, Saibil F, et al. 5-Aminosalicylic acid enema in the treatment of distal ulcerative colitis, proctosigmoiditis, and proctitis. Gastroenterology. 1987; 92:1894–1898.
Erbayrak M, Turkay C, Eraslan E, Cetinkaya H, Kasapoglu B, Bektas M. The role of fecal calprotectin in investigating inflammatory bowel diseases. Clinics (Sao Paulo) 2009; 64:421–425.
Geboes K, Riddell R, Ost A, Jensfelt B, Persson T, Löfberg R. A reproducible grading scale for histological assessment of inflammation in ulcerative colitis. Gut 2000; 47:404–409.
Stange EF, Travis SP, Vermeire S, Reinisch W, Geboes K, Barakauskiene A, et al. European Crohn’s and Colitis Organisation (ECCO) European evidence-based Consensus on the diagnosis and management of ulcerative colitis: definitions and diagnosis. J Crohns Colitis 2008; 2:1–23.
D’Haens G, Sandborn WJ, Feagan BG, Geboes K, Hanauer SB, Irvine EJ, et al. A review of activity indices and efficacy end points for clinical trials of medical therapy in adults with ulcerative colitis. Gastroenterology 2007; 132:763–786.
Burger D, Thomas SJ, Walsh AJ, et al. Depth of remission may not predict outcome of ulcerative colitis over 2 years. J Crohn’s Colitis 2011; 5:S4–S5.
Riley SA, Mani V, Goodman MJ, Dutt S, Herd ME. Microscopic activity in ulcerative colitis: what does it mean?. Gut 1991; 32:174–178.
Bitton A, Peppercorn MA, Antonioli DA, Niles JL, Shah S, Bousvaros A, et al. Clinical, biological, and histologic parameters as predictors of relapse in ulcerative colitis. Gastroenterology 2001; 120:13–20.
Rubin DT, Huo D, Hetzel JT, et al. Increased degree of histological inflammation predicts colectomy and hospitalization in patients with ulcerative colitis [abstract]. Gastroenterology 2007; 132:A-19.
Thomas SJ, Walsh AJ, Von Herbay A, et al. How much agreement is there between histological, endoscopic and clinical assessments of remission in ulcerative colitis. Gut 2009; 58:A101.
Yokoyama K, Kobayashi K, Mukae M, Sada M, Koizumi W. Clinical study of the relation between mucosal healing and long-term outcomes in ulcerative colitis. Gastroenterol Res Pract 2013; 2013:192794.
Solem CA, Loftus EV Jr, Tremaine WJ, Harmsen WS, Zinsmeister AR, Sandborn WJ. Correlation of C-reactive protein with clinical, endoscopic, histologic, and radiographic activity in inflammatory bowel disease. Inflamm Bowel Dis 2005; 11:707–712.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Elgamal, A., Maklouf, H. Evaluation of false remission in ulcerative colitis and the need for a revised disease activity index. Egypt J Intern Med 26, 151–156 (2014). https://doi.org/10.4103/1110-7782.148129
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.4103/1110-7782.148129