To determine the prognostic importance of microscopic rectal inflammation we followed up The macroscopic appearances of the rectal mucosa were graded using well established criteria.7 Only patients with normal mucosal appearances or erythema were included in the study. Those with contact bleeding, spontaneous bleeding, or ulceration were specifically excluded as most of these patients have pronounced histological features of inflammation.5Only patients taking either oral sulphasalazine or oral mesalazine as sole maintenance treatment were recruited. Those taking other drugs known to have an effect on colitis activity were excluded. No patient had received either oral or rectal steroids within four weeks of inclusion. HISTOLOGICAL ASSESSMENTAt the time of sigmoidoscopy a mucosal biopsy specimen was taken from the anterior rectal wall between 5 and 10 cm from the anal margin. Biopsy specimens were fixed in formalin, embedded in paraffin, and 5 micron sections were stained with haematoxylin and eosin. Sections were then coded and graded independently by two histopathologists who had no knowledge of the patients.Six histological features were assessed: the acute inflammatory cell infiltrate (polymorphonuclear cells in the lamina propria), crypt abscesses (Fig 1), mucin depletion (Fig 2), surface epithelial integrity, the chronic inflammatory cell infiltrate (round cells in the lamina propria), and crypt architectural irregularities.8 Each feature was graded on a four point scale corresponding to none, mild, moderate, or severe. The final grade being the mean of the two independent assessments. PATIENT FOLLOW UPPatients attended for clinical review at three, six, nine, and 12 months or at any other time if they wished. Throughout the study patients were asked to report promptly with symptomatic deterioration. Sigmoidoscopy was then undertaken and a stool culture performed. Colitis relapse was confirmed if the macroscopic appearance of the rectal mucosa had become haemorrhagic and the stool culture was negative.All results are expressed as median and range unless otherwise stated. Relapse data were analysed using the X2 test with Yates's correction.

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To determine the factors responsible for ulcerative colitis relapse a cohort of 92 patients (18 to 78 years, 50 men) with clinically inactive disease have been We have therefore followed a cohort of patients with quiescent colitis in order to study: (a) the clinical features that may predict relapse; (b) the events preceding relapse; and (c) the timing of ulcerative colitis relapse. We have also undertaken a retrospective case note analysis to assess the timing of onset of first attack of ulcerative colitis.