Published online Jun 7, 2016. doi: 10.3748/wjg.v22.i21.5079
Peer-review started: March 13, 2016
First decision: March 21, 2016
Revised: March 31, 2016
Accepted: May 4, 2016
Article in press: May 4, 2016
Published online: June 7, 2016
Processing time: 78 Days and 24 Hours
AIM: To assess the risk of relapse in ulcerative colitis (UC) patients in clinical remission using mucosal status and fecal immunochemical test (FIT) results.
METHODS: The clinical outcomes of 194 UC patients in clinical remission who underwent colonoscopy were based on evaluations of Mayo endoscopic subscores (MESs) and FIT results.
RESULTS: Patients with an MES of 0 (n = 94, 48%) showed a ten-fold lower risk of relapse than those with an MES of 1-3 (n = 100, 52%) (HR = 0.10, 95%CI: 0.05-0.19). A negative FIT result (fecal hemoglobin concentrations ≤ 100 ng/mL) was predictive of patients with an MES of 0, with a sensitivity of 0.94 and a specific of 0.76. Moreover, patients with a negative FIT score had a six-fold lower risk of clinical relapse than those with a positive score (HR = 0.17, 95%CI: 0.10-0.28). Inclusion of the distinguishing parameter, sustaining clinical remission > 12 mo, resulted in an even stronger correlation between negative FIT results and an MES of 0 with respect to the risk of clinical relapse (HR = 0.11, 95%CI: 0.04-0.23).
CONCLUSION: Negative FIT results one year or more after remission induction correlate with complete mucosal healing (MES 0) and better prognosis. Performing FIT one year after remission induction may be useful for evaluating relapse risk.
Core tip: Mucosal healing has been recognized as the treatment goal of. In this study, the relapse rate differed greatly between patients with a Mayo endoscopic subscore (MES) of 0 and an MES of 1 such that mucosal healing should be defined as an MES of 0. We previously reported that a negative fecal immunochemical test (FIT) correlates positively with mucosal healing. This paper indicated that patients with a negative FIT demonstrated a lower risk of clinical relapse than those with a positive FIT and that the risk of relapse in patients in prolonged remission and with a negative FIT was equivalent to that of patients with an MES of 0.