Abstract Background Inflammatory Bowel Disease (IBD) treatment goals have evolved, now striving for a treat-to-target strategy. In Ulcerative colitis (UC) deep remission has been proposed as a novel therapeutic goal consisting of a combination of clinical, biochemical, endoscopic and histologic remission. The only validated activity index that encompasses all these parameters is Yamamoto-Furusho Integral Index. In this study we aim to study the prognostic capacities of the Integral Index and how it impacts for treatment optimization. Methods A cohort study that included 72 patients with definitive diagnosis of UC who had at least two evaluations including patient related outcomes, biomarkers, colonoscopy findings and histopathological evaluations in the period between January 2019 and June 2025. We used the Yamamoto-Furusho Integral Index already validated in our population, which include clinical parameters (diarrhea and bloody stools), biochemical parameters (hemoglobin, ultrasensitive C reactive protein and albumin), endoscopic (Mayo endoscopic sub-score) and histologic activity for treatment optimization. Statistical analysis was performed using SPSS V25 software. A P value of 0.05 was considered as statistically significant. Results We included 72 patients with UC diagnosis The mean follow-up time was 56 months (range: 21-78 months). The deep remission improved from 45.8% to 56.9% with treatment optimization. We found that patients with severe activity were significantly associated with emergency department visits (P = 0.01; OR = 12.3, CI 95% 1.3-112.9); more hospitalizations (P = 0.002; OR = 22.5, CI 95%: 2.4-219.5) and more need for surgery (P = 0.02; OR = 22.3, CI 95%= 1.7-283.6). Patients with moderate activity had a significantly higher risk for relapse (P = 0.008; OR = 5.9, CI 95% 1.5-23.3). In contrast, patients with deep remission had better outcomes, such as lack of relapse (P = 0.005; OR = 0.24, CI 95%: 0.09-0.65) and less hospitalizations (P = 0.0007; OR = 5.9, CI 95%: 2.0-17.0). In the analysis by treatment optimization strategies, oral plus topical administration of mesalazine was the most effective strategy associated with lower relapses (P = 0.0004; OR = 0.08, CI 95% 0.01-0.41), less emergency department visits (P = 0.03; OR = 0.28M CI 95%: 0.09-0.89) and improvement in the integral disease activity (P 0.00001; OR = 78.3, CI 95% 9.1-669.9). Conclusion The rate of deep remission improved from 45.8% to 56.9% in Mexican patients with UC using this validated novel integral disease activity or Yamamoto-Furusho index. Moreover, we found that this index can predict better clinical outcomes such as lack of relapse, less visits to emergency department and less hospitalizations. Conflict of interest: Prof. Dr. Yamamoto-Furusho, Jesús Kazuo: No conflict of interest Gutierrez-Herrera, Fausto Damian: No conflict of interest
Yamamoto-Furusho et al. (Thu,) studied this question.