The effect of endoscopic remission on the prognosis in ulcerative colitis

AIM: Ulcerative colitis is a chronic inflammatory disease characterized by remissions and relapses. The primary treatment goal is to achieve clinical and endoscopic remission. Mayo endoscopic subscore is used in the evaluation of endoscopic activity. This study aims to determine the impact of endoscopic remission (MSe 0 or 1) on prognosis, clinical relapse rates, and relapse-free time in patients with UC who are in clinical remission. MATERIALS AND METHODS: Between January 2009 and December 2023, medical records of patients with UC who underwent colonoscopic examination during the clinical remission period at Sakarya Training and Research Hospital Gastroenterology Clinic were retrospectively reviewed. The partial Mayo score was used to evaluate clinical activity and MSe was used to assess endoscopic activity. RESULTS: The study included 157 patients, 42.1% female and a mean age of 51.64±14.57 years. Among patients, 37.6% had pancolitis, 40.1% had left-sided colitis, and 22.3% had proctitis. Endoscopic disease activity at the time of clinical remission was MSe 1 in 46.8% (n=74) and MSe0 in 53.1% (n=83). There were no significant differences in baseline demographic characteristics of patients such as age, gender, body mass index, disease duration, disease extent, smoking, alcohol use, family history, extraintestinal symptoms, and medication. Clinical relapse occurred in 26.5% (n=42) of the patients. The relapse rate was significantly higher in patients with MSe 1 than those with MSe 0 (40.5% vs 14.4%, p=0.010). The remission duration was significantly shorter in patients with MSe 1 compared to those with MSe 0 (29.36±16.30 vs 43.58±25.10 months, p=0.036). There was no significant relationship between relapse and age, gender, disease extent, smoking, baseline treatment and CRP levels. CONCLUSION: The study indicates that patients with UC who are in clinical remission with MSe 0 have a lower risk of relapse and a longer remission duration than MSe 1. These findings suggest that achieving complete mucosal healing should be considered a therapeutic goal in UC. Keywords: Clinical remission, Mayo score, ulcerative colitis.