1. Feasibility of endoscopic assessment and treating to target to achieve mucosal healing in ulcerative colitis
- Author
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William J. Sandborn, Elisabeth Evans, Barrett G. Levesque, Guillaume Bouguen, Suresh Pola, Foie, métabolismes et cancer, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université de Rennes (UNIV-RENNES), Division of Gastroenterology, University of California [San Diego] (UC San Diego), University of California-University of California, University of California, Gastroenterology, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université de Rennes (UR), University of California (UC)-University of California (UC), and University of California (UC)
- Subjects
Adult ,Male ,medicine.medical_specialty ,[SDV]Life Sciences [q-bio] ,Inflammatory bowel disease ,Gastroenterology ,Severity of Illness Index ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Severity of illness ,medicine ,Immunology and Allergy ,Humans ,Cumulative incidence ,Colitis ,Intestinal Mucosa ,Retrospective Studies ,Wound Healing ,medicine.diagnostic_test ,business.industry ,Mucous membrane ,Retrospective cohort study ,Colonoscopy ,Middle Aged ,medicine.disease ,Ulcerative colitis ,3. Good health ,Endoscopy ,medicine.anatomical_structure ,Treatment Outcome ,030220 oncology & carcinogenesis ,Feasibility Studies ,030211 gastroenterology & hepatology ,Colitis, Ulcerative ,Female ,business ,Follow-Up Studies - Abstract
Background Mucosal healing (MH) as a treatment target for ulcerative colitis is of growing interest because it is associated with improved clinical outcomes. However, the feasibility and probability of reaching MH in clinical practice is unknown. We therefore evaluated the feasibility of "treating to target" according to endoscopic findings to reach MH. Methods All endoscopic outcomes of patients with ulcerative colitis followed in a single inflammatory bowel disease unit from 2011 to 2012 were reviewed and subsequent therapeutic management. Cumulative incidence of MH and histologic healing (HH) were estimated using a Kaplan-Meier method. Results A total of 60 patients underwent at least 2 consecutive endoscopic assessments, of whom 45 and 48 patients had endoscopic and histologic evidence of active disease, respectively. After a median follow-up of 76 weeks, 27 of 45 (60%) patients with endoscopic disease activity at baseline achieved MH and 24 (50%) of 48 patients with histologic disease activity at baseline had HH. The cumulative probabilities of MH were 26%, 52%, and 70% at 26, 52, and 76 weeks, respectively. The cumulative probabilities of HH at weeks 26, 52, and 76 from the time of initial procedure were 19%, 41%, and 57%, respectively. Any adjustment in medical therapy in case of persistent endoscopic activity was associated with both MH and HH. Conclusions Repeated assessment of endoscopic disease activity with adjustment of medical therapy to the target of MH is feasible in clinical practice in patients with ulcerative colitis, and seems to be of benefit.
- Published
- 2014