TOPLINE:

In patients with ulcerative colitis who had endoscopic healing, achieving transmural healing was associated with longer relapse-free survival. Women and those who had received multiple advanced therapies showed a higher risk for relapse.

METHODOLOGY:

• Researchers conducted a retrospective study at an Amsterdam University Medical Centre (January 2017 to June 2024) to assess the impact of transmural healing on long-term outcomes in 61 patients (mean age, 43.5 years; 52.5% men) with ulcerative colitis.
• They analysed patients who had endoscopic healing (Mayo Endoscopic Subscore [MES] ≤ 1), underwent an intestinal ultrasound within 6 months of endoscopy, received stable maintenance therapy without corticosteroids before endoscopy or ultrasound, and completed at least 6 months of clinical follow-up post-endoscopy.
• Intestinal ultrasound examinations were performed; transmural healing was defined as a bowel wall thickness < 3 mm on all colonic segments.
• The primary outcome was relapse-free survival, with the relapse of ulcerative colitis being defined as the presence of any two of the following: a Simple Clinical Colitis Activity Index of ≥ 5 or relapse as per the Physician's Global Assessment, faecal calprotectin levels ≥ 250 μg/g, or an MES ≥ 2 on any bowel segment.
• Outcomes were assessed over a median follow-up duration of 20.3 months.

TAKEAWAY:

• The overall relapse-free survival rates of the cohort were 86.2% in the first year, 66.8% in the second year, 53.1% in the third year, and 46.4% in the fourth year.
• At baseline, 44 patients had transmural healing, with 23 having relapse during follow-up. Relapse-free survival was longer in those who achieved transmural healing than in those who did not (log-rank test, P = .004).
• The mean time to the first relapse was 20.9 months for the transmural healing group vs 12.2 months for the non-transmural healing group (P = .042). The first-year relapse risk was 7.5% with transmural healing vs 29.4% without, and the second-year relapse risk was 20.5% vs 64.3%, respectively.
• Factors such as female sex (adjusted hazard ratio [aHR], 2.63; P = .04), previous use of two or more advanced therapies (aHR, 4.06; P = .04), and not achieving transmural healing (aHR, 3.99; P = .02) were associated with relapse.

IN PRACTICE:

"TH [transmural healing] is associated with a lower risk of relapse in UC [ulcerative colitis] patients with EH [endoscopic healing] and can be used to further stratify risk of relapse among patients with MES 1. IUS [intestinal ultrasound] could therefore offer a non-invasive and cost-effective alternative to assess risk of relapse and guide de-escalation strategies in patients with UC," the authors of the study wrote.

SOURCE:

This study was led by Chong-Teik Lim and Christoph Teichert, Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, the Netherlands. It was published online on August 22, 2025, in the Journal of Crohn's and Colitis.

LIMITATIONS:

Transmural healing was defined only on the basis of bowel wall thickness, without integrating other parameters such as colour Doppler signal, fat wrapping, or haustration pattern. The procedure time and interval between endoscopy and intestinal ultrasound could not be standardised owing to the study's retrospective nature. The findings applied only to patients with ulcerative colitis with left sided or extensive colitis.

DISCLOSURES:

This study did not receive any specific funding. Three authors reported receiving research grants, consulting fees, speaker fees, and/or honoraria, with one of them serving on the data monitoring board for various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.