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Ulcerative colitis patients in clinical remission demonstrate correlations between fecal immunochemical test results, mucosal healing, and risk of relapse

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World Journal of Gastroenterology 2016年第21期22卷 5079-5087页

作者： Asuka Nakarai Jun Kato Sakiko Hiraoka Shiho Takashima Daisuke Takei toshihiro inokuchi Yuusaku Sugihara Masahiro Takahara Keita Harada Hiroyuki Okada Department of Gastroenterology and Hepatology Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences Second Department of Internal Medicine Wakayama Medical University Department of Endoscopy Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences

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 ***: 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/m L) 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.

关键词： Ulcerative colitis Clinical remission Mucosal healing Mayo endoscopic subscore Quantitative fecal im

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Long-term follow-up of ulcerative colitis patients treated on the basis of their cytomegalovirus antigen status

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World Journal of Gastroenterology 2014年第2期20卷 509-517页

作者： toshihiro inokuchi Jun Kato Sakiko Hiraoka Hideyuki Suzuki Asuka Nakarai Tomoko Hirakawa Mitsuhiro Akita Sakuma Takahashi Keita Harada Hiroyuki Okada Kazuhide Yamamoto Department of Gastroenterology and Hepatology Okayama University Graduate School of MedicineDentistry and Pharmaceutical SciencesOkayama 700-8558Japan Second Department of Internal Medicine Wakayama Medical UniversityWakayama 641-0012Japan

AIM:To clarify the impact of cytomegalovirus(CMV)activation and antiviral therapy based on CMV antigen status on the long-term clinical course of ulcerative colitis(UC)***:UC patients with flare-up were divided into CMV-positive and-negative groups according to the CMV antigenemia *** main treatment strategy provided for the patients in the CMV-positive group comprised a dose reduction of corticosteroids and administration of ***:The median number of days to initial remission was significantly greater for the patients in the CMV-positive group(21 d vs 16 d,P=0.009).However,the relapse rate after remission and colectomy rate during more than 30 mo of observation did not differ between the two *** analysis revealed that administration of ganciclovir was the only independent factor for avoiding colectomy in patients of the CMV-positive ***:CMV antigen status did not significantly affect the long-term prognosis in UC patients under treatment with appropriate antiviral therapy.

关键词： Ulcerative colitis Cytomegalovirus Cytomegalovirus

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Prognosis of ulcerative colitis differs between patients with complete and partial mucosal healing, which can be predicted from the platelet count

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World Journal of Gastroenterology 2014年第48期20卷 18367-18374页

作者： Asuka Nakarai Jun Kato Sakiko Hiraoka toshihiro inokuchi Daisuke Takei Yuki Moritou Mitsuhiro Akita Sakuma Takahashi Keisuke Hori Keita Harada Hiroyuki Okada Kazuhide Yamamoto Department of Gastroenterology and Hepatology Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences Okayama 700-8558 Japan Second Department of Internal Medicine Wakayama Medical University Wakayama 641-0012 Japan Department of Endoscopy Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences Okayama 700-8558 Japan

AIM:To determine the difference in clinical outcome between ulcerative colitis(UC)patients with Mayo endoscopic subscore(MES)0 and those with MES ***:UC patients with sustained clinical remission of 6 mo or more at the time of colonoscopy were examined for clinical outcomes and the hazard ratios of clinical relapse according to ***,including blood tests,to identify predictive factors for MES 0and slight endoscopic recurrence in clinically stablepatients were ***,a receiver operating characteristic curve was generated,and the area under the curve was calculated to indicate the utility of the parameters for the division between complete and partial mucosal *** P values were two-sided and considered significant when less than ***:A total of 183 patients with clinical remission were *** with MES 0(complete mucosal healing:n=80,44%)were much less likely to relapse than those with MES 1(partial mucosal healing:n=89,48%)(P<0.0001,log-rank test),and the hazard ratio of risk of relapse in patients with MES 1 vs MES0 was 8.17(95%CI:4.19-17.96,P<0.0001).The platelet count(PLT)<26×104/μL was an independent predictive factor for complete mucosal healing(OR=4.1,95%CI:2.15-7.99).Among patients with MES 0 at the initial colonoscopy,patients of whom colonoscopy findings shifted to MES 1 showed significant increases in PLT compared to those who maintained MES 0(3.8×104/μL vs-0.6×104/μL,P<0.0001).CONCLUSION:The relapse rate differed greatly between patients with complete and partial mucosal healing.A shift from complete to partial healing in clinically stable UC patients can be predicted by monitoring PLT.

关键词： Ulcerative colitis Mucosal healing Platelet count

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