Evaluation of false remission in ulcerative colitis and the need for a revised disease activity index

Abstract

Aim of the work To highlight some criteria of remission in ulcerative colitis, to address the issue of false remission, and settle a standard index for its detection. Patients and methods Patients with ulcerative colitis in clinical remission were enrolled prospectively and followed for 1 year for evaluation of clinical manifestations, C-reactive protein, fecal calprotectin, and tumor necrosis factor-α, and colonoscopic and microscopic examination for the detection of actual remission, with the exclusion of those who developed clinical relapse during the study. Results Out of 36 patients, we had 11 patients (30.5%) with true remission and 25 patients (69.5%) with false remission: 19 patients (52.7%) in false remission group A with abnormal mucosal healing and six patients (16%) in false remission group B with high inflammatory markers. There was a significant positive correlation of inflammatory markers with the ulcerative colitis disease activity index in patients with true remission. There was a significant correlation of the ulcerative colitis disease activity index and histological grades in false remission A and a significant correlation of inflammatory markers with histological grades in false remission B. Conclusion About 70% of our patients with ulcerative colitis in clinical remission had an active disease. Clinical remission in ulcerative colitis can be best expressed as true and false remission depending on histological grading in a revised ulcerative colitis disease activity index. Some inflammatory markers can be useful for the detection of true remission.

Keywords

• False remission, revised ulcerative colitis disease activity index, true remission, ulcerative colitis