Prognostic Value of Terminal Ileal Inflammation in Patients with Ulcerative Colitis
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Background/Aims: Few studies have investigated terminal ileal lesions and their prognostic value in patients with ulcerative colitis (UC). We evaluated the clinical significance of these lesions as a prognostic factor in patients with UC who were in clinical remission. Methods: We retrospectively selected 567 of 4,066 colonoscopy reports that included positive findings from orificial observations of the terminal ileum (TI) and appendix in patients with UC. We finally recruited patients who were in clinical remission (n=204). We compared the clinical courses, including relapse and other prognostic parameters associated with UC, between the groups. Results: The baseline patient characteristics were not significantly different between patients with (n=69, TI+ group) and without TI lesions (n=135, TI– group), although there were more never-smokers in the TI+ group (n=57 [82.6%] in the TI+ group; n=86 [63.7%] in the TI– group; p=0.005). Of note, appendiceal orifice inflammation (AOI) was less frequently found in the TI+ group (14.5%) than in the TI– group (71.9%, p<0.001). The cumulative relapse rate was numerically higher in the TI– group, but it was not significantly different according to the Kaplan-Meier analysis (p=0.116). Multivariate Cox regression analysis also revealed advanced age at diagnosis as the most significant factor (adjusted hazard ratio, 0.964; 95% confidence interval, 0.932 to 0.998; p=0.037), but neither TI inflammation nor AOI were significantly associated with the cumulative relapse rate in patients with UC in clinical remission. Conclusions: For patients with UC in clinical remission, neither terminal ileal lesions nor AOI had significant clinical or predictive value for future relapse.
Abstract
Background/Aims: Few studies have investigated terminal ileal lesions and their prognostic value in patients with ulcerative colitis (UC). We evaluated the clinical significance of these lesions as a prognostic factor in patients with UC who were in clinical remission. Methods: We retrospectively selected 567 of 4,066 colonoscopy reports that included positive findings from orificial observations of the terminal ileum (TI) and appendix in patients with UC. We finally recruited patients who were in clinical remission (n=204). We compared the clinical courses, including relapse and other prognostic parameters associated with UC, between the groups. Results: The baseline patient characteristics were not significantly different between patients with (n=69, TI+ group) and without TI lesions (n=135, TI– group), although there were more never-smokers in the TI+ group (n=57 [82.6%] in the TI+ group; n=86 [63.7%] in the TI– group; p=0.005). Of note, appendiceal orifice inflammation (AOI) was less frequently found in the TI+ group (14.5%) than in the TI– group (71.9%, p<0.001). The cumulative relapse rate was numerically higher in the TI– group, but it was not significantly different according to the Kaplan-Meier analysis (p=0.116). Multivariate Cox regression analysis also revealed advanced age at diagnosis as the most significant factor (adjusted hazard ratio, 0.964; 95% confidence interval, 0.932 to 0.998; p=0.037), but neither TI inflammation nor AOI were significantly associated with the cumulative relapse rate in patients with UC in clinical remission. Conclusions: For patients with UC in clinical remission, neither terminal ileal lesions nor AOI had significant clinical or predictive value for future relapse.
참고문헌 (41)
- McGovern DP, "Genome-wide association identifies multiple ulcerative colitis susceptibility loci", Nat Genet, 42, pp.332~337 (2010)
- Cleynen I, "Inherited determinants of Crohn’s disease and ulcerative colitis phenotypes : a genetic association study", Lancet, 387, pp.156~167 (2016)
- Triantafillidis JK, "Current and emerging drugs for the treatment of inflammatory bowel disease", Drug Des Devel Ther, 5, pp.185~210 (2011)
- Kim B, "Proximal disease extension and related predicting factors in ulcerative proctitis", Scand J Gastroenterol, 49, pp.177~183 (2014)
- Lee HJ, "Long-term clinical outcomes and factors predictive of relapse after 5-aminosalicylate or sulfasalazine therapy in patients with mild-to-moderate ulcerative colitis", Hepatogastroenterology, 59, pp.1415~1420 (2012)
- Colombel JF, "Outcomes and strategies to support a treat-to-target approach in inflammatory bowel disease : a systematic review", J Crohns Colitis, 14, pp.254~266 (2020)
- Höie O, "Ulcerative colitis : patient characteristics may predict 10-yr disease recurrence in a European-wide population-based cohort", Am J Gastroenterol, 102, pp.1692~1701 (2007)
- Frøslie KF, "Mucosal healing in inflammatory bowel disease : results from a Norwegian population-based cohort", Gastroenterology, 133, pp.412~422 (2007)
- Beaugerie L, "Impact of cessation of smoking on the course of ulcerative colitis", Am J Gastroenterol, 96, pp.2113~2116 (2001)
- Kim JH, "Effect of mucosal healing(Mayo 0)on clinical relapse in patients with ulcerative colitis in clinical remission", Scand J Gastroenterol, 51, pp.1069~1074 (2016)
- Jingzhou Wang, "Polypharmacy is a risk factor for disease flare in adult patients with ulcerative colitis: a retrospective cohort study", Intestinal research, 17(4), pp.496~503 (2019), 대한장연구학회[DOI]
- Matsushita M, "Pathophysiology of the appendix in ulcerative colitis", Am J Gastroenterol, 113, pp.622~ (2018)
- Anzai H, "Appendiceal orifice inflammation is associated with proximal extension of disease in patients with ulcerative colitis", Colorectal Dis, 18, pp.O278~ (2016)
- Park SH, "Appendiceal skip inflammation and ulcerative colitis", Dig Dis Sci, 59, pp.2050~2057 (2014)
- Byeon JS, "Clinical course of distal ulcerative colitis in relation to appendiceal orifice inflammation status", Inflamm Bowel Dis, 11, pp.366~371 (2005)
- McHugh JB, "The diagnostic value of endoscopic terminal ileum biopsies", Am J Gastroenterol, 102, pp.1084~1089 (2007)
- Jeong SH, "Diagnostic value of terminal ileum intubation during colonoscopy", J Gastroenterol Hepatol, 23, pp.51~55 (2008)
- Sayilir A, "Diagnostic value of terminal ileum biopsy in chronic diarrhea with normal endoscopic appearance", J Dig Dis, 12, pp.188~192 (2011)
- Börsch G, "Endoscopy of the terminal ileum", Lancet, 2, pp.573~574 (1984)
- Chang HS, "Isolated terminal ileal ulcerations in asymptomatic individuals : natural course and clinical significance", Gastrointest Endosc, 72, pp.1226~1232 (2010)
- Bojic D, "Terminal ileitis is not always Crohn’s disease", Ann Gastroenterol, 24, pp.271~275 (2011)
- Sands BE, "From symptom to diagnosis : clinical distinctions among various forms of intestinal inflammation", Gastroenterology, 126, pp.1518~1532 (2004)
- Lewis JD, "Use of the noninvasive components of the Mayo score to assess clinical response in ulcerative colitis", Inflamm Bowel Dis, 14, pp.1660~1666 (2008)
- "Achieving clinical response and remission in moderateto-severe ulcerative colitis with golimumab", Gastroenterol Hepatol (N Y), 10, pp.452~454 (2014)
- Hamilton MJ, "Prospective evaluation of terminal ileitis in a surveillance population of patients with ulcerative colitis", Inflamm Bowel Dis, 22, pp.2448~2455 (2016)
- Goldstein NS, "Isolated ileal erosions in patients with mildly altered bowel habits : a follow-up study of 28 patients", Am J Clin Pathol, 125, pp.838~846 (2006)
- Turner D, "Assessing disease activity in ulcerative colitis: patients or their physicians?", Inflamm Bowel Dis, 16, pp.651~656 (2010)
- Manginot C, "An endoscopic Mayo score of 0 is associated with a lower risk of colectomy than a score of 1 in ulcerative colitis", Gut, 64, pp.1181~1182 (2015)
- O’Connor A, "Poor correlation between patientreported and endoscopic components of the Mayo score in ulcerative colitis", Gastroenterology, 150, pp.1037~1039 (2016)
- Fukuda T, "Efficacy of therapeutic intervention for patients with an ulcerative colitis Mayo endoscopic score of 1", Inflamm Bowel Dis, 25, pp.782~788 (2019)
- Satsangi J, "The Montreal classification of inflammatory bowel disease : controversies, consensus, and implications", Gut, 55, pp.749~753 (2006)
- Barreiro-de Acosta M, "Evaluation of the risk of relapse in ulcerative colitis according to the degree of mucosal healing(Mayo 0 vs 1) : a longitudinal cohort study", J Crohns Colitis, 10, pp.13~19 (2016)
- D’Haens G, "A review of activity indices and efficacy end points for clinical trials of medical therapy in adults with ulcerative colitis", Gastroenterology, 132, pp.763~786 (2007)
- Lobatón T, "The modified Mayo endoscopic score(MMES) : a new index for the assessment of extension and severity of endoscopic activity in ulcerative colitis patients", J Crohns Colitis, 9, pp.846~852 (2015)
- Yamamoto T, "Mucosal inflammation in the terminal ileum of ulcerative colitis patients : endoscopic findings and cytokine profiles", Dig Liver Dis, 40, pp.253~259 (2008)
- Patil DT, "Backwash is hogwash : the clinical significance of ileitis in ulcerative colitis", Am J Gastroenterol, 112, pp.1211~1214 (2017)
- Haskell H, "Pathologic features and clinical significance of"backwash"ileitis in ulcerative colitis", Am J Surg Pathol, 29, pp.1472~1481 (2005)
- To N, "Systematic review with metaanalysis : the effect of tobacco smoking on the natural history of ulcerative colitis", Aliment Pharmacol Ther, 44, pp.117~126 (2016)
- Reinisch W, "Factors associated with poor outcomes in adults with newly diagnosed ulcerative colitis", Clin Gastroenterol Hepatol, 13, pp.635~642 (2015)
- Matsumoto T, "Significance of appendiceal involvement in patients with ulcerative colitis", Gastrointest Endosc, 55, pp.180~185 (2002)
- Yang SK, "Appendiceal orifice inflammation as a skip lesion in ulcerative colitis : an analysis in relation to medical therapy and disease extent", Gastrointest Endosc, 49, pp.743~747 (1999)