Hemorrhagic rectocolitis (UC) belongs to the family of chronic inflammatory bowel diseases (IBD). It is an inflammatory bowel disease affecting the rectum and sometimes all or part of the colon. This chronic disease evolves in relapses, alternating with phases of remission.

The aim of maintenance therapy for UC is to maintain clinical and endoscopic remission, without corticosteroids. Clinical remission is defined as the absence of rectal bleeding and fewer than 4 bowel movements per 24 h. Endoscopic remission correlates with an overall improvement in the course of the disease. The absence of acute histological inflammation is predictive of disease remission.

Ulcerative colitis, Clinical, Endoscopic, Biological, Remission.

Salim S, Chakir A, Touibi Y, Lamsiah T (2022) Concordance between Clinical, Endoscopic and Biological Remission in Ulcerative Colitis. JSM Gastroenterol Hepatol 9(1): 1108.

The main objective of this study was to evaluate the correlation between clinical, endoscopic and biological remission in UC

This is a single-centre descriptive study during a period from January 2016 to July 2021 of all UC patients in clinical remission of their disease who underwent surveillance colonoscopy; the extent and activity was classified according to the Mayo endoscopy score [1-8].

Of the 40 UC patients in clinical remission, only 24 (60%) were in endoscopic remission; 12 (30%) had endoscopic inflammatory involvement, classified as Mayo 2 and (10%) classified as Mayo 3. These active colonic lesions were pan-colonic in 6 patients (36%), left colic in 26 (24%), rectal in 8 (20%); a biological inflammatory syndrome was present in 15 patients (26%), presented by a CRP and hyperferritinemia [9-11].

The concordance between the severity of the endoscopic involvement (Mayo score) and the severity of the biological involvement was only 35%.

The biological damage was only 35.6%, better for the Mayo 0 score (40.3%) and poor for the Mayo 3 (13.7%) [11,12].

Concerning the extent of inflammatory involvement, the concordance was 68.9%, it was better for pancolic (80%) and rectal (60.4%) involvement [13-16].

In UC, there is a poor correlation between clinical remission, endoscopic and biological healing. There is little agreement between endoscopy and biology in assessing the extent of inflammatory involvement and its severity.

1. Magro F, Gionchetti P, Eliakim R, Ardizzone S, Armuzzi A, Barreiro- de Acosta M, et al. Third European Evidence-Based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, diagnosis and special situations: extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disorders. J Crohns Colitis. 2017; 11: 649-670.
2. Harbord M, Eliakim R, Bettenworth D, Karmiris K, Katsanos K, Kopylov U, et al. Third European Evidence-Based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 2: Current Management. J Crohns Colitis. 2017; 11: 769-784.
3. Ford AC, Khan KJ, Achkar JP. Efficacy of oral vs. topical, or combined oral and topical 5-aminosalicylates, in Ulcerative Colitis: systematic review and meta-analysis. Am J Gastroenterol. 2012; 107: 167-76; author reply 177.
4. Sandborn WJ, Bosworth B, Zakko S, et al. Budesonide foam induces remission in patients with mild to moderate ulcerative proctitis and ulcerative proctosigmoiditis. Gastroenterology. 2015; 148: 740-75.
5. Feagan BG, Chande N, MacDonald JK. Are there any differences in the efficacy and safety of different formulations of Oral 5-ASA used for induction and maintenance of remission in ulcerative colitis? evidence from cochrane reviews. Inflamm Bowel Dis. 2013; 19: 2031-40.
6. Van Assche G, Manguso F, Zibellini M, et al. Oral prolonged releasebeclomethasone dipropionate and prednisone in the treatment of active ulcerative colitis: results from a double-blind, randomized, parallel group study. Am J Gastroenterol. 2015; 110: 943.
7. Sandborn WJ, Danese S, D’Haens G, et al. Induction of clinical and colonoscopic remission of mild-to-moderate ulcerative colitis with budesonide MMX 9 mg: pooled analysis of two phase 3 studies. Aliment Pharmacol Ther. 2015; 41: 409-18.
8. Williams JG, Alam MF, Alrubaiy L, et al. Infliximab vs ciclosporin for steroid-resistant acute severe ulcerative colitis (CONSTRUCT): a mixed methods, open-label, pragmatic randomized trial. Lancet Hepatol Gastroenteral. 2016; 1: 15-24.
9. Sandborn WJ, Feagan BG, Marano C, Zhang H, Strauss R, Johanns J, et al. Subcutaneous golimumab induces clinical response and remission in patients with moderate-to-severe ulcerative colitis. Gastroenterology. 2014; 146: 85-95.
10. Sandborn WJ, Feagan BG, Marano C, et al. Subcutaneous golimumab maintains clinical response in patients with moderate-to-severe ulcerative colitis. Gastroenterology. 2014; 146: 96-109.e1.
11. Feagan BG, Rutgeerts P, Sands BE, et al. Vedolizumab as induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2013; 369: 699-710.
12. Carbonnel F, Colombel JF, Filippi J, et al. Methotrexate Is Not Superior to Placebo for Inducing Steroid-Free Remission, but Induces Steroid- Free Clinical Remission in a Larger Proportion of Patients With Ulcerative Colitis. Gastroenterology. 2016; 150: 380-8.e4.
13. SandbornW SB, D’Haens GR, et al. Efficacy and safety of oral tofacitinib as induction therapy in patients with moderate to severe ulcerative colitis: results from two phase 3 randomized controlled trials. Gastroenterology. 2016: S157.
14. Panaccione R, Ghosh S, Middleton S, et al. Combination therapy with infliximab and azathioprine is superior to monotherapy with either agent in ulcerative colitis. Gastroenterology. 2014; 146: 392-400.
15. Shah SC, Colombel JF, Sands BE, et al. Mucosal Healing is Associated with Improved Long-term Outcomes of Patients With Ulcerative Colitis: a Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2016; 14: 1245-1255.
16. Bressler B, Marshall JK, Bernstein CN, et al. Clinical practice guidelines for the medical management of nonhospitalized ulcerative colitis: the Toronto consensus. Gastroenterology. 2015; 148: 1035-1058.