Disease Clearance Reduces the Risk of Adverse Outcomes and Provides Additional Benefit Beyond Individual Clinical, Endoscopic, or Histological Remission in Ulcerative Colitis

<b>Background and Aims:</b> Recent advances in Ulcerative Colitis (UC) treatment have the potential to improve clinical outcomes if inflammation is controlled. The emerging concept of "disease clearance" (DC) aims to achieve combined clinical, endoscopic, and histological remission. However, whether DC is associated with better outcomes remains unclear. This study aimed to evaluate the impact of DC on UC patients. <b>Methods:</b> Consecutive UC patients who underwent colonoscopy and had clinical follow-up of at least 18 months were included between September 2012 and December 2017. Clinical condition (Patient-Reported Outcome, PRO), Mayo endoscopic score (MES), and histopathology (Geboes score, GS) were assessed at baseline and every 6 months. Disease clearance (DC) was defined as simultaneous clinical remission (PRO2 = 0), endoscopic remission (MES = 0), and histological remission (GS ≤ 2). <b>Results:</b> A total of 101 UC patients with a median time since diagnosis of 103 ± 102 months were included. At baseline colonoscopy, 52 patients (51.5%) achieved DC. These subjects had a lower rate of negative outcomes than those without DC (21.2% vs. 59.2%, <i>p</i> < 0.001). Kaplan-Meier curves confirmed a lower risk of clinical relapse in DC patients (log-rank, <i>p</i> = 0.001). Among patients with endoscopic remission, only those with DC had a lower risk of negative outcomes (21.2% vs. 75%, <i>p</i> < 0.01). Achieving DC reduced the risk of flare-ups even in patients with clinical remission or histological remission. <b>Conclusions:</b> Achieving DC in UC patients reduces the risk of negative outcomes during follow-up, supporting its inclusion as a key composite treatment goal in UC management.