EC Gastroenterology and Digestive System

Introduction: Ulcerative colitis belongs to the group of IBD, inflammatory bowel disease, a chronic inflammatory disease with relapses, occurs at any age, more common in young or middle-aged people. The incidence in the US is around 10 - 12 cases per year per 100,000, with a peak incidence at the age of 15 - 25, and the prevalence is 1/1000. Inflammation almost always affects the rectum, is continuous and can affect the entire colon, spreads in the mucosa and to a lesser extent in the submucosa. The main histological features are crypt abscesses, disturbed crypt architecture and mucin depletion. In 55% of cases desease has a form of proctitis, in 30% has the form of left-sided colitis, and in 15% as extensive colitis. It is a chronic inflammatory disease, which imposes the need for more precise measurement of the degree of its activity. Clinicians use laboratory parameters such as sedimentation (ESR), C reactive protein (CRP), leucocytes (WBC) or platelet (Plt), associated with frequent invasive methods (endoscopic assessments)for assessing the activity of ulcerative colitis (UC). Powell-Tuck index or Mayo score similar to the Disease Activity Index (DAI) described by Sutherland., et al. are used, Powell-Tuck index from 1978 includes some laboratory like ESR, RBC (red blood cells), Alb. (albumins), or clinical parameters such as the presence of tachycardia, elevated temperature, dehydration.

Aim of the Study: To show the value of clinical scores in assessing UC activity.To compare scores and individual laboratory parameters in the assessment of UC activity.

Materials and Methods: Retrospective study conducted on patients treated at the Department of Gastroenterology and Surgery of the General Hospital Leskovac and Gastroenterology Clinic of Clinical Center Nis, from January 2015 to December 2019. Diagnosis based on history, clinical parameters, laboratory, endoscopy with pathohistology, radiological exploration. Patients older than 18 years, and up to 83 years are included, average age 54.69 ± 17.32 years. Total of 72 patients, 41 (57%) men and 31 (43%) women, and divided, according to clinical parameters into three groups related to disease activity: mild (10 patients,13.9%), moderate (47 patients, 65.3%) and severe (15 patients, 20.8%) disease. We used and compared the values of complete and partial, as well as numerical two-component score to monitor disease activity, together with endoscopic and laboratory parameters. We used Pearson correlation test and Student t statistical tests.

Results: We demonstrated a statistically significant correlation between the Mayo score and the simplified partial (r = 0.93, p = 0.01) and numerical Mayo score (r = 0.73, p = 0.01) in the assessment of UC activity, as well as between the partial and numerical Mayo score (r = 0.81, p = 0.01). We have thus proved that partial Mayo scores and 6-point numerical scores composed only of components such as stool count and bleeding can be as effective as full Mayo scores in assessing UC activity and determining the clinical response in patients. Based on significant differences between clinical stages of UC, we detected different levels of ESR (p ˂ 0.05), Fe (serum iron) (p ˂ 0.05), and Alb. (p ˂ 0.05).

Conclusion: The significance of these parameters is that a simple assessment of disease activity is achieved, without frequent use of invasive methods, with a very correlated value with the complete Mayo score and numeric two component score. Of the laboratory parameters, level of ESR, Fe, and Alb., could play a significant role in assessing UC activity.

Keywords: Ulcerative Colitis; Mayo Score; Correlation

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