Nakarai A, Kato J, Hiraoka S, Takashima S, Takei D, Inokuchi T, Sugihara Y, Takahara M, Harada K, Okada H. Ulcerative colitis patients in clinical remission demonstrate correlations between fecal immunochemical test results, mucosal healing, and risk of relapse. World J Gastroenterol 2016; 22(21): 5079-5087 [PMID: 27275100 DOI: 10.3748/wjg.v22.i21.5079]
Corresponding Author of This Article
Dr. Sakiko Hiraoka, Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama 700-8558, Japan. sakikoh@cc.okayama-u.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jun 7, 2016; 22(21): 5079-5087 Published online Jun 7, 2016. doi: 10.3748/wjg.v22.i21.5079
Ulcerative colitis patients in clinical remission demonstrate correlations between fecal immunochemical test results, mucosal healing, and risk of relapse
Asuka Nakarai, Sakiko Hiraoka, Shiho Takashima, Toshihiro Inokuchi, Yuusaku Sugihara, Masahiro Takahara, Hiroyuki Okada, Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-0914, Japan
Jun Kato, Second Department of Internal Medicine, Wakayama Medical University, Wakayama 641-0012, Japan
Daisuke Takei, Keita Harada, Department of Endoscopy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-0914, Japan
Author contributions: All authors contributed to this paper.
Institutional review board statement: This study was reviewed and approved for publication by our Institutional Reviewer.
Informed consent statement: All study participants or their legal guardians provided informed written consent regarding personal and medical data collection prior to study enrollment.
Conflict-of-interest statement: All authors have no conflicts of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available upon request from the corresponding author at sakikoh@cc.okayama-u.ac.jp.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Sakiko Hiraoka, Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama 700-8558, Japan. sakikoh@cc.okayama-u.ac.jp
Telephone: +39-321-3733413 Fax: +39-321-3733142
Received: March 13, 2016 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
Abstract
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.
