Relapse of ulcerative colitis is difficult to predict by routine colonoscopy.
A high-resolution video-magnifying colonoscope with chromoscopy enables the observation of colorectal mucosal pit patterns.
Dr Ando and colleagues from Japan investigated the association of pit patterns in patients with quiescent ulcerative colitis.
The research team prospectively analysed the prognostic factors that may predict exacerbations.
The pit patterns were assessed by magnifying colonoscopy with histological inflammation and mucosal chemokine activity.
|60% of patients with magnifying colonoscopy grade 4 relapsed|
The team performed magnifying colonoscopy in 113 patients with ulcerative colitis in remission.
Pit patterns in the rectal mucosa were classified into 4 magnifying colonoscopy grades on the basis of size, shape and arrangement.
Mucosal interleukin 8 activity was measured in biopsy specimens of rectal mucosa.
The team assessed the specimens for histological disease activity.
The patients were then followed until relapse or for a maximum of 12 months.
The researchers carried out multivariate survival analysis to determine the independent predictors of clinical relapse.
The team identified a positive correlation between magnifying colonoscopy grade, histological grade, and mucosal interleukin 8 activity.
Multivariate proportional hazard model analysis showed that magnifying colonoscopy grade was a significant predictor of relapse.
The researchers found that Kaplan-Meier estimate of relapse during 12 months of follow-up increased with increasing magnifying colonoscopy grade.
The team observed that the values were 0% for grade 1, 21% for grade 2, 43% for grade 3 and 60% for grade 4.
Dr Ando's team concludes, “Magnifying colonoscopy grading is associated with the degree of histological inflammation and mucosal interleukin-8 activity in patients with quiescent ulcerative colitis.”
“It may predict the probability of subsequent disease relapse in patients with ulcerative colitis in remission.”