Increased Rectal Wall Thickness May Predict Relapse in Ulcerative Colitis: A Pilot Follow-Up Study by Ultrasonographic Colonoscopy

Background and Study Aims: Ulcerative colitis is a chronic inflammatory bowel disease with repeated remission and relapse, although the occurrence of relapse is difficult to predict. We performed a prospective study to determine whether there is a relationship in ulcerative colitis between the inflammatory changes identified by endoscopic ultrasonography (EUS) and relapse.
Patients and Methods: Participants were 23 ulcerative colitis patients who had not suffered a relapse for 1 month, with a Seo activity index ≤ 150 and Baron grade 1 at colonoscopy. The thickness of the first to the third layer of the rectal wall in these patients was measured by EUS at the start of the study. They were subsequently followed up for 1 year to record any relapses, defined as having a Seo activity index > 150 and Baron grade ≥ 2 at colonoscopy.
Results: Relapse occurred in eight patients. The mean activity index of the relapsed patients was 187.3 (95 % confidence interval (CI), 166.4 - 208.2) at the end of the study. The thickness of the first to the third layer of the rectal wall, as evaluated by EUS at the beginning of the study, was significantly larger in the relapse group (mean 2.73 mm, 95 % CI 2.13 - 3.33 mm) than in the nonrelapse group (1.79 mm; 1.56 - 1.99 mm; P = 0.0001).
Conclusions: Catheter probe-assisted endoluminal ultrasonography may predict the occurrence of relapse of ulcerative colitis.

References

• 1 Edwards F C, Truelove S C. The course and prognosis of ulcerative colitis. Part I. Short-term prognosis. Part II. Long-term prognosis.  Gut. 1963;  4 299-315
• 2 Truelove S C, Witts L J. Cortisone in ulcerative colitis. Final report on a therapeutic trial.  Br Med J. 1955;  2 1041-1048
• 3 Powell-Tuck J, Bown R L, Lennard-Jones J E. A comparison of oral prednisolone given as single or multiple daily doses for active proctocolitis.  Scand J Gastroenterol. 1978;  13 833-837
• 4 Seo M, Okada M, Yao T. et al . An index of disease activity in patients with ulcerative colitis.  Am J Gastroenterol. 1992;  87 971-976
• 5 Matts S GF. The value of rectal biopsy in the diagnosis of ulcerative colitis.  Q J Med. 1961;  30 393-407
• 6 Baron J H, Connell A M, Lennard-Jones J E. Variation between observers in describing mucosal appearances in proctocolitis.  Br Med J. 1964;  i 89-92
• 7 Riley S A, Mani V, Goodman M J. et al . Microscopic activity in ulcerative colitis: what does it mean?.  Gut. 1991;  32 174-178
• 8 Ludwig D, Wiener S, Bruning A. et al . Mesenteric blood flow is related to disease activity and risk of relapse in ulcerative colitis: a prospective follow up study.  Gut. 1999;  45 546-552
• 9 Rasmussen S N, Riis P. Rectal wall thickness measured by ultrasound in chronic inflammatory diseases of the colon.  Scand J Gastroenterol. 1985;  20 109-114
• 10 Cho E, Yasuda K, Nakajima M. Endoscopic ultrasonography (EUS) in the diagnosis of ulcerative colitis.  Gastroenterology. 1990;  98 (part 2) A164
• 11 Shimizu S, Tada M, Kawai K. Value of endoscopic ultrasonography in the assessment of inflammatory bowel diseases.  Endoscopy. 1992;  24 (Suppl 1) 354-358
• 12 Arienti V, Campieri M, Boriani L. et al . Management of severe ulcerative colitis with the help of high resolution ultrasonography.  Am J Gastroenterol. 1996;  91 2163-2169
• 13 Dubbins P A. Ultrasound demonstration of bowel wall thickness in inflammatory bowel disease.  Clin Radiol. 1984;  35 227-231
• 14 Aibe T, Fuji T, Okita K. et al . A fundamental study of normal layer structure of the gastrointestinal wall visualized by endoscopic ultrasonography.  Scand J Gastroenterol. 1986;  21 (Suppl 123) 6-15
• 15 Silverstein F E, Martin R W, Kimmey M B. et al . Experimental evaluation of an endoscopic ultrasound probe: in vitro and in vivo canine studies.  Gastroenterology. 1989;  96 1058-1062
• 16 Kimmey M B, Martin R W, Haggitt R C. et al . Histologic correlates of gastrointestinal ultrasound images.  Gastroenterology. 1989;  96 433-441
• 17 Soweid A M, Chak A, Katz J A. et al . Catheter probe-assisted endoluminal US in inflammatory bowel disease.  Gastrointest Endosc. 1999;  50 41-46
• 18 Tsuga K, Haruma K, Fujimura J. et al . Evaluation of the colorectal wall in normal subjects and patients with ulcerative colitis using an ultrasonic catheter probe.  Gastrointest Endosc. 1998;  48 477-484
• 19 Matsuura S, Awaya S, Higaki S. et al . Endosonographic diagnosis of early colon cancer and ulcerative colitis [In Japanese with English abstract].  Endoscopia Digestiva. 1993;  5 177-182
• 20 Dagli U, Over H, Tezel A. et al . Transrectal ultrasound in the diagnosis and management of inflammatory bowel disease.  Endoscopy. 1999;  31 152-157
• 21 Truelove S C, Richards W CD. Biopsy studies in ulcerative colitis.  Br Med J. 1956;  i 1315-1318
• 22 Dick A P, Holt L P, Dalton E R. Persistence of mucosal abnormality in ulcerative colitis.  Gut. 1966;  7 355-360
• 23 Powell-Truck J, Day D W, Buckell N A. et al . Correlations between defined sigmoidoscopic appearances and other measures of disease activity in ulcerative colitis.  Dig Dis Sci. 1982;  27 533-537
• 24 Langholz E, Munkholm P IA, Davidsen M. et al . Course of ulcerative colitis: analysis of changes in disease activity over years.  Gastroenterology. 1994;  107 3-11
• 25 Jarnerot G, Rolny P, Sandberg-Gertzen H. Intensive intravenous treatment of ulcerative colitis.  Gastroenterology. 1985;  89 1005-1013
• 26 Moum B, Ekbom A, Vatn M H. et al . Clinical course during the 1st year after diagnosis in ulcerative colitis and Crohn's disease.  Scand J Gastroenterol. 1997;  32 1005-1012
• 27 Riley S A, Mani V, Goodman M J. et al . Why do patients with ulcerative colitis relapse?.  Gut. 1990;  31 179-183
• 28 Rijk M CM, van Lier H JJ, van Tongeren J HM. Relapse-preventing effect and safety of sulfasalazine and olsalazine in patients with ulcerative colitis in remission: a prospective, double-blind, randomized multicenter study.  Am J Gastroenterol. 1992;  87 438-442
• 29 Nilsson A, Danielsson A, Lofberg R. et al . Olsalazine versus sulphasalazine for relapse prevention in ulcerative colitis: a multicenter study.  Am J Gastroenterol. 1995;  90 381-387
• 30 Kiilerich S, Ladefoged K, Rannem T. et al . Prophylactic effects of olsalazine vs. sulphasalazine during 12 months maintenance treatment of ulcerative colitis.  Gut. 1992;  33 252-255