Gastroenterology

Gastroenterology

Volume 133, Issue 2, August 2007, Pages 412-422
Gastroenterology

Clinical–alimentary tract
Mucosal Healing in Inflammatory Bowel Disease: Results From a Norwegian Population-Based Cohort

https://doi.org/10.1053/j.gastro.2007.05.051Get rights and content

Background & Aims: Mucosal healing (MH) in inflammatory bowel disease may be an important sign of efficacy of treatment and a prognostic marker of long-term disease. The aim of the study was to examine both the possible predictors of mucosal healing and the impact of healing on subsequent course of disease. Methods: In 740 incident patients diagnosed with ulcerative colitis (UC) or Crohn’s disease (CD) between 1990 and 1994 (before biologic therapy was available), demographics and symptoms were recorded. Clinical and endoscopic evaluations were done at baseline before treatment and repeated after 1 and 5 years in 495 patients. Results: In UC patients, education longer than 12 years and extensive disease at diagnosis were significant predictors of MH after 1 year (adjusted P = .004 and P = .02, respectively). MH was significantly associated with a low risk of future colectomy (P = .02). In patients with CD, fever at diagnosis and medical treatment without steroids were significant predictors for MH (adjusted P = .03 and P = .01, respectively). MH was significantly associated with less inflammation after 5 years (P = .02), decreased future steroid treatment (P = .02). Conclusions: Several factors predicted subsequent MH. Education as predictor may implicate the importance of coping, compliance, or lifestyle. MH after 1 year of treatment is predictive of reduced subsequent disease activity and decreased need for active treatment. The present results give further strength to the use of mucosal healing as a clinical indicator and treatment goal in inflammatory bowel disease.

Section snippets

Study Population

The present population-based cohort of 843 incident cases of IBD in Norway was collected from 1990 to 19945 and subjected to a scheduled prospective follow-up, with a 1-year visit and a 5-year visit. The cohort was established during collaboration among 15 hospitals and 1236 general practitioners. The patients were treated on an individual basis between the scheduled visits at the hospital. These visits took place at baseline, when the diagnosis was established and treatment started, and at the

Results

Information on a total of 513 incident UC patients was available from the Inflammatory Bowel disease in SouthEastern Norway (IBSEN) study. After exclusion of patients undergoing colectomy during the first year after diagnosis (n = 15), and those who did not meet within the time limits for the 1-year visit (n = 50), 448 UC patients were eligible for the 1-year follow-up. Of these, 94 were not examined by colonoscopy for different reasons (Table 1). The first year relapse frequency in patients

Summary

The present study shows that the prediction of MH based on characteristics of patients is complex. It was, however, possible to identify risk factors for inflammatory activity after 1 year of individual treatment. The results were mostly based on multiple logistic regression analyses, but univariate significant associations were also noted. Additionally, indications on the predictive value of established MH after 1 year of treatment for the subsequent outcome of disease were found.

In UC, MH at

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Supported partially by CENTOCOR INC. for the IBSEN study.

There is no conflict of interest for any of the authors.

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