Predictive value of Milan ultrasound criteria in ulcerative colitis: A prospective observational cohort study. Issue 2 (1st March 2022)

• Record Type: Journal Article
• Authors: Allocca, Mariangela; Dell'Avalle, Cecilia; Craviotto, Vincenzo; Furfaro, Federica; Zilli, Alessandra; D'Amico, Ferdinando; Bonovas, Stefanos; Peyrin‐Biroulet, Laurent; Fiorino, Gionata; Danese, Silvio
• Is Part Of: United European Gastroenterology journal. Volume 10:Issue 2(2022)
• Page Start: 190
• Page End: 197
• Publication Date: 2022-03-01
• Subjects: inflammatory bowel disease -- Milan ultrasound criteria -- outcomes -- predictive value -- ulcerative colitis -- ultrasound; Gastroenterology -- Periodicals; Periodicals; 616.33005
• DOI: 10.1002/ueg2.12206
• Languages: English
• ISSNs: 2050-6406

Abstract

Abstract: Background: Endoscopic healing is an established treatment target for ulcerative colitis (UC). We have recently validated the Milan ultrasound criteria (MUC) to assess endoscopic activity in UC; a MUC score > 6.2 is a valid cut‐off to discriminate endoscopic activity (Mayo endoscopic subscore > 1). Objective: The aim of this study was to assess the predictive value of MUC on disease course in a prospective cohort of UC patients. Methods: UC patients regardless of disease activity and current therapy, underwent colonoscopy and bowel ultrasound (US) at baseline in a blinded fashion. Correlations between baseline MUC and Mayo endoscopic subscore were assessed using Spearman's rank correlation. UC‐related negative course (defined as the need for corticosteroids, or treatment escalation, or hospitalization, or need for colectomy: a composite outcome) over a median 20 months follow‐up, was investigated using the Kaplan‐Meier method and Cox regression analysis. Results: 98 UC patients were followed up for a median time of 1.6 years (IQR 0.9¬2.7). Milan ultrasound criteria and Mayo endoscopic subscore significantly correlated at baseline ( ρ = 0.653; p < 0.001). 70 patients (71%) had negative disease course during the follow‐up period. Milan ultrasound criteria > 6.2 at baseline was statistically significantly associated with negative disease course (HR: 3.87, 95% CI: 2.25–6.64, p < 0.001). Kaplan–Meier analyses drawed a statistically significantly lower cumulative probability of treatment escalation, need of corticosteroids, hospitalization and colectomy, among patients who had MUC ≤ 6.2 at baseline as compared to patients with MUC > 6.2 ( p < 0.05 for all outcomes). Conclusion: we have demonstrated for the first time the value of bowel US and an US score in predicting disease course in UC. Milan ultrasound criteria, a validated US‐based score, predicts disease course in UC. Milan ultrasound criteria ≤ 6.2 may be the new treatment target to achieve to reduce the risk of worse outcomes.