Comparing the Continuous Geboes Score With the Robarts Histopathology Index: Definitions of Histological Remission and Response and their Relation to Faecal Calprotectin Levels

Abstract

Background and Aims The histological status of ulcerative colitis [UC] patients in clinical and endoscopic remission has gained space as an important prognostic marker and a key component of disease monitoring. Our main aims were to compare two histological indexes—the continuous Geboes score [GS] and the Robarts Histopathology index [RHI]—regarding their definitions of histological remission and response, and the ability of faecal calprotectin [FC] levels to discriminate between these statuses. Methods This was an analysis of three prospective cohorts including 422 patients previously enrolled in other studies. Results The two continuous scores [GS and RHI] were shown to be significantly correlated [correlation coefficient of 0.806, p < 0.001] and particularly close regarding their definition of histological response: 95% and 88% of all patients classified as having/not having [respectively] histological response according to RHI also did so according to GS. Moreover, median FC levels in patients with histological response were lower than those in patients without histological response [GS: 73.00 vs 525.00, p < 0.001; RHI: 73.50 vs 510.00, p < 0.001]; a similar trend was observed when FC levels of patients in histological remission were compared to those of patients with histological activity [GS: 76.00 vs 228.00, p < 0.001; RHI: 73.50 vs 467.00, p < 0.001]. FC levels allowed us to exclude the absence of histological remission [according to RHI] and absence of histological response [according to RHI and GS], with negative predictive values varying from 82% to 96%. However, optimization of the FC cut-off to exclude the absence of histological remission, as for the continuous GS, falls within values that resemble those of the healthy population. Conclusion The continuous GS and RHI histological scores are strongly correlated in their definitions of histological response. An absence of histological remission could only be excluded at physiological levels of FC.

Review article: faecal calprotectin and histologic remission in ulcerative colitis

“…Seven studies 14,[25][26][27][28]30,31 used partially validated scores (Geboes score, Nancy index and Robarts histopathologic score) for histologic remission definition, while in six studies 13,15,29,32,33 histologic healing was based on nonvalidated scores. Comparative trials 31,40,41 revealed a strong correlation between Geboes score, Nancy index and Robarts score suggesting that the available validated scores may provide overlapping data. Instead, a study by Römkens et al 42 showed that the correlation between the nonvalidated scores and between the nonvalidated and validated scores was moderate, highlighting how the histologic score can influence patient management and therapeutic decisions.…”

Fecal calprotectin concentration to assess endoscopic and histologic remission in patients with cancer with immune-mediated diarrhea and colitis

“…Several studies [36][37][38] confirmed that FC can detect histologic remission and with threshold being lower than that of endoscopic remission. Although a validated cut-off FC to predict histologic remission has not been established, Open access our results confirm the role of FC as a predictive marker for histologic remission in patients with IMDC.…”

Histological scores in inflammatory bowel disease

“…When assessing the usefulness of FC for predicting the histological degree of inflammation in UC colon, results were quite disappointing as well. 47 The authors conclude that FC levels may be useful to exclude the improvement of histological activity, while caution is required for predicting histological remission, as histological activity may be observed even in cases with normal FC levels. Among the strengths of the ECAP score is its focus on the residual inflammation assessed by histology, whose clinical meaning has not yet been fully defined, even though it has been suggested that a deep remission predicts a better global clinical outcome.…”