Background: Discrepancies between clinical symptoms and mucosal inflammation have been reported in up to 50% of patients with ulcerative colitis (UC). However, there are no guidelines and only limited information for appropriate treatment manipulation. Aim: We aimed to evaluate long-term outcomes according to treatment strategies and determine predictive factors for disease relapse in UC patients who are in clinical remission (CR) but still have endoscopic inflammation. Methods: A total of 204 patients who were confirmed as achieving CR but still had mucosal inflammation were included. CR was defined as “partial Mayo score ≤ 1” with no changes in medications or use of any corticosteroids during the past 3 months. An active mucosal lesion was defined as “endoscopic Mayo subscore > 0.” Results: The mean patient age was 43.5 years, and 53.9% were male. The mean disease duration was 89.9 months. During a mean follow-up of 34 months, 90 patients (44%) experienced disease relapse. The cumulative relapse-free rate did not differ by treatment strategy (maintenance of current therapy vs. dose elevation or step-up therapy). Multivariate analysis revealed that left-side colitis or pancolitis at diagnosis (OR 2.10; 95% CI 1.04–4.27; P = 0.040) and number of extraintestinal manifestations ≥ 2 (OR 5.62; 95% CI 1.10–28.68; P = 0.038) were independent predictive factors for disease relapse. Conclusions: The current medical acceleration treatment strategy did not have a significant influence on the long-term outcomes of UC patients in CR but with active mucosal inflammation. Disease extent at diagnosis and extraintestinal manifestations were independently predictive of disease relapse.
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