Background:
Ulcerative colitis (uc) patients often report symptom flares after colonoscopy. however, this has not been documented in the literature.
Objectives:
- determine whether colonoscopy is associated with increased uc symptoms. 2. determine whether there is a need for escalation of uc medications after colonoscopy. 3. identify baseline variables associated with increased symptoms after colonoscopy.
Methods:
Fifty-five outpatients with a history of uc, intact colon, and quiescent disease were enrolled in a prospective case-crossover study. subjects were evaluated with the simple clinical colitis activity index (sccai) before colonoscopy, 1 week and 4 weeks after colonoscopy. a mixed model analysis was used to accommodate nonindependence of repeated measurements on the same patients.
Results:
Fifty-one (91%) subjects completed the study. six subjects had clinical relapse defined by a score of 5 or greater on the sccai during the week after colonoscopy. five subjects increased their 5-aminosalicylic acid (5-asa) medications immediately postcolonoscopy, two of whom had a sccai 5 or greater. multivariate modeling demonstrated a clear association between the week immediately after colonoscopy preparation and increased disease activity, with the time period being predictive of increased sccai (week 1 vs. week 4, p = 0.0127). the baseline sccai (p value < 0.0001) and prednisone use (p = 0.0120) were predictive of increased sccai postcolonoscopy. thiopurines (p < 0.001) were protective against increased symptoms.
Conclusions:
In our study, 1 in 8 subjects had uc relapse by sccai immediately postcolonoscopy, and 1 in 10 subjects required an increase in their 5-asa medications. clinicians should be cognizant of this effect of colonoscopy in patients with uc.