How well do changes in stool frequency and rectal bleeding correlate with endoscopic remission in ulcerative colitis?
Changes in rectal bleeding correlate better with changes in the endoscopic activity of ulcerative colitis than do changes in stool frequency, but neither performs well.
Ma C, Sandborn WJ, D’Haens GR, et al. Discordance Between Patient-Reported Outcomes and Mucosal Inflammation in Patients with Mild to Moderate Ulcerative Colitis. Clin Gastroenterol Hepatol. Epub ahead of print September 20, 2019; https://doi.org/10.1016/j.cgh.2019.09.021.
To determine correlations among rectal bleeding, stool frequency and endoscopic remission in patients with ulcerative colitis, researchers in Canada, Europe and the United States analyzed data from a phase 3 trial of 817 adults with mild-to-moderate disease extending at least 15 cm from the anal verge who were treated with mesalazine. Patient-reported rectal bleeding and stool frequency scores were correlated with Mayo endoscopic subscores (MESs) at baseline and weeks eight and 38. Endoscopic remission was defined as a MES of 0 or 1.
The authors found that, at week eight, 16% of patients with a MES of 0 or 1 reported having visible blood in stool at least half the time, and 52% said they had a higher-than-normal stool frequency. At week 38, 4% of those with a MES of 0 or 1 had blood in stool at least half the time and 38% said they had higher-than-normal stool frequency. Among patients whose MESs improved at week eight, 10% had unchanged or worsening rectal bleeding and 21% had unchanged or increased stool frequency. Additionally, 51% of those whose MES remained unchanged or worsened during the study nevertheless experienced reduced stool frequency while 56% had reduced rectal bleeding.
Study Design: Post-hoc analysis of randomized trial
Allocation: Not applicable
Level of Evidence: 2b (Oxford Levels of Evidence)
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