Laharie, David; Bourreille, Arnaud; Branche, Julien; Allez, Matthieu; Bouhnik, Yoram; Filippi, Jerome; Zerbib, Frank; Savoye, Guillaume; Vuitton, Lucine; Moreau, Jacques; Amiot, Aurelien; Beaugerie, Laurent; Ricart, Elena; Dewit, Olivier; Lopez-Sanroman, Antonio; Fumery, Mathurin; Carbonnel, Franck; Buisson, Anthony; Coffin, Benoit; Roblin, Xavier; van Assche, Gert; Esteve, Maria; Färkkilä, Martti; Gisbert, Javier P.; Marteau, Philippe; Nahon, Stephane; de Vos, Martine; Peyrin-Biroulet, Laurent; Mary, Jean-Yves
(2021)
BACKGROUND/AIMS: Few data on the evolution of endoscopic findings are available in patients with acute severe ulcerative colitis (ASUC). The aim of this study was to describe this evolution in a prospective cohort. METHODS: Patients admitted for a steroid-refractory ASUC and included in a randomized trial comparing infliximab and cyclosporine were eligible if they achieved steroid-free clinical remission at day 98. Flexible sigmoidoscopies were performed at baseline, days 7, 42 and 98. Ulcerative colitis endoscopic index of severity (UCEIS) and its sub-scores - vascular pattern, bleeding and ulceration/erosion - were post-hoc calculated. Global endoscopic remission was defined by a UCEIS of 0, and partial endoscopic remission by any UCEIS sub-score of 0. RESULTS: Among the 55 patients analyzed (29 infliximab and 26 cyclosporine), 49 (83%) had UCEIS >= 6 at baseline at baseline. Partial endoscopic remission rates were higher for bleeding than for vascular pattern and for ulcerations/erosions at day 7 (20% vs. 4% and 5% (n = 55); p CONCLUSION: In steroid-refractory ASUC patients responding to a second-line medical therapy, endoscopic remission process started with bleeding remission and was not achieved in half the patients at day 98 for vascular pattern. Infliximab provided a higher endoscopic remission rate than cyclosporine at day 98.