Discrepancies seen between symptoms, objective findings in ulcerative colitis

Last Updated: 2016-10-11

By Will Boggs MD

NEW YORK (Reuters Health) - Patients with ulcerative colitis (UC) continue to report symptoms despite endoscopic and histological remission, researchers report.

"Even when a patient is in 'deep' endoscopic and histologic remission he can still have symptoms with increased number of stools and urgency," Dr. Jean-Frédéric Colombel from Icahn School of Medicine at Mount Sinai, New York, told Reuters Health by email.

While rectal bleeding and stool frequency are commonly used to monitor disease activity in patients with UC, recent work shows that resolution of clinical symptoms does not always follow endoscopic healing.

Dr. Colombel and colleagues used data from the EMBARK study to examine the relationship of symptoms to objective measures of inflammation in patients that continued to have symptoms.

Of the 103 patients studied, 61 had inactive disease as measured by endoscopy, the team reports in Gut, online September 2.

Increasing symptom scores were associated with a decreased likelihood of having endoscopic remission (a Mayo endoscopic subscore of 0), but 5% of patients without endoscopic activity still reported rectal bleeding and 18% reported increased stool frequency.

Similarly, many patients with histological remission continued to report rectal bleeding (24%) or increased stool frequency (39%).

UC biomarker levels did not differ significantly between patients categorized under different definitions of mucosal healing, with or without histological healing.

"Our work highlights the possibility that it may be very difficult for a therapy to achieve complete remission of symptoms even in the presence of endoscopic and histological healing," the researchers conclude. "Furthermore, we do not observe additional value by using histological evaluation in patients with no evidence of disease on endoscopic evaluation, but longitudinal outcomes studies will be required to completely evaluate the value of histology," they add.

"UC is not only a mucosal disease," Dr. Colombel said. "Don't dismiss complaints of patients because they are in endoscopic and histologic healing. Don't call them 'IBS.' They may suffer a lot from these symptoms with impact on quality of life."

"We need to understand if there are other components (neurological?) on which we could act to reduce symptoms," he added. "This is also a plea to get tight control of the disease from its onset."

Genentech funded the study, employed four of the seven authors, and had various relationships with the other three authors, including Dr. Colombel.

SOURCE: http://bit.ly/2bYMrQo

Gut 2016.