Rate and Predictors of Mucosal Healing in Ulcerative Colitis Treated with Thiopurines: Results of a Multicentric Cohort Study.

BACKGROUND AND AIMS: Mucosal healing (MH) with thiopurines has been poorly investigated in ulcerative colitis (UC). We aimed to assess MH rate in UC patients treated with thiopurine monotherapy. PATIENTS AND METHODS: We retrospectively collected all UC patients treated with thiopurines more than 6 months who have undergone colonoscopy at baseline and after at least 6 months of treatment. Patients were recruited from January 2005 to May 2015 through a personal database and/or standardized hospital inpatient diagnostic dataset. Patients were excluded in case of any use of other immunomodulator or biological agent. MH was defined as a Mayo endoscopic subscore ≤1 and UCEIS ≤ 2. Histological healing (HH) was defined by the absence of epithelial polynuclear infiltrate, cryptic abscesses, or ulcerations. RESULTS: Eighty patients (31 women, median age 43 [IQR 32-58]) were included. Median disease duration was 10.5 [6-16] years. At baseline, median full Mayo score, endoscopic subscore, and UCEIS were 8 [6.8-10], 3 [2-3], and 5 [3-6], respectively. MH was first assessed after a mean follow-up of 38 ± 31 months. Median full Mayo score, endoscopic subscore, and UCEIS decreased to 3.5 [1-6], 2 [0-2.2], and 2 [0-4], respectively. MH was achieved in 43.7%, HH in 38%. In multivariate analysis, predictors of MH were thiopurine exposure duration ≥2 years [odds ratio (OR) 2.9, CI 95% (1.1-7.6), p = 0.03] and a prior acute severe colitis [OR 5.9, CI 95% (1.1-32), p = 0.04]. Factors associated with MH during treatment were partial Mayo score ≤2 (NPV = 100%), BMI ≥ 25 kg/m2 (NPV = 75%), and MCV ≥ 95 fL (NPV = 73%). CONCLUSIONS: In UC, thiopurine monotherapy is associated with MH in 43.7% and HH in 38%.

Gastric polyp prolapsed into the duodenum as a rare cause of acute pancreatitis.

Mechanical gastric polyp complications are very rare occurrences most commonly related to hyperplastic polyps. We report here the case of a young woman with a 12-cm adenomatous polyp on the great curvature of the stomach diagnosed incidentally during tests for anaemia. Later, the patient was referred to hospital for recurrent emergency due to acute pancreatitis caused by the polyp prolapsing into the duodenum. A two-step treatment was undertaken: the first procedure consisted of a surgical polypectomy followed by a second-step total gastrectomy for cancer necessitated by the presence of an invasive adenocarcinoma on the polyp. This case proves malignant adenomatous polyps to be exceptionally responsible for mechanical complications such as acute pancreatitis due to polyp prolapsing into the duodenum. In such a complicated case, we recommend deferredemergency resection of the polyp followed subsequently by gastrectomy for cancer when histologically indicated.