Background: Mucosal healing (MH) has been associated with improved outcomes in patients with Ulcerative Colitis (UC) including lower requirement of steroids, hospitalization, and surgery. Most studies have been limited by the analysis of small cohorts of patients over a short follow-up time. Furthermore, the difference in obtaining MH with different therapies has seldom been assessed. The aim of this was study was to compare the long-term outcomes of patients with UC and MH in relation to the degree of endoscopic remission (endoscopic Mayo score of 0 or 1) and according to therapeutic regimen used (aminosalycilates, thiopurines or anti-TNFs).
Methods: Observational study including patients with UC and MH. Patients were followed from the baseline endoscopy showing MH until recurrence. Recurrence was defined as the need for hospitalization, surgery, change in therapy and endoscopic recurrence (defined as endoscopic Mayo subscore >1). Patients with a follow-up under 12 months were excluded from analysis.
Results: From a cohort of 453 patients with UC, 212 were studied from the time of MH. The mean time from diagnosis to MH was 72.2±101.6 months and the mean follow-up time was 91.1±59.4 months. MH was achieved with in 161 patients under 5-ASA (75.9%), in 41 patients under thiopurines (19.3%), and in 10 patients under anti-TNF (4.7%). The time until recurrence was significantly longer in patients with Mayo 0 (80.0±60.5 months versus 61.0±49.6 months, p=0.019). While there was no significant difference in 12-month recurrence (log-rank p=0.236), 5-year (log-rank p=0.005), and 10-year (log-rank p=0.045) recurrence rates were significantly higher in patients with Mayo 1. The percentage of patients achieving Mayo 0 was not influenced by the drug used (p=0.7), nor were recurrence rates (log-rank p=0.144) or time until recurrence (p=0.120). Patients not reaching MH were more likely to need surgery (12.4% versus 1.4%, p<0.001). Disease extension (OR 11.5 95% CI 4.1–32.2, p<0.001), male gender (OR 2.3 95% 1.04–5.25, p=0.039) and not obtaining MH (OR 13.4 95% CI 3.6–42.7, p<0.001) were significant associated with the need for surgery.
Conclusions: MH was an achievable target associated with long-standing remission irrespective of the drug used.