Histologic remission does not offer additional benefit for ulcerative colitis patients in endoscopic remission

Narula, Neeraj; Aruljothy, Achuthan; Alshahrani, Abdul‐Aziz; Fadida, M; Al-Saedi, Mona; Marshall, John K.; Rubin, David T.; Christensen, Britt

doi:10.1111/apt.16147

Cited by 20 publications

(1 citation statement)

References 35 publications

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“…This trended to significance within 1-year post-index colonoscopy and reached significance when outcome data was extended to all follow-ups. Our data demonstrates conflicting results with a recent retrospective study by Narula et al, 12 which did not find a significant difference in time to relapse in patients classified in endoscopic remission that were further stratified to groups based on the presence of histologic activity. Both studies were completed at 2 tertiary academic IBD centers; however, our study utilized a validated scoring system with the RHI to define histologic remission, which may have represented a more stringent and consistent definition of histologic remission.…”

Section: Discussioncontrasting

confidence: 99%

Histologic Inflammation can Predict Future Clinical Relapse in Ulcerative Colitis Patients in Endoscopic Remission

George,

Feldman,

Alizadeh

et al. 2023

Crohn's &Amp; Colitis 360

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Background In ulcerative colitis (UC), endoscopic improvement, defined as a Mayo Endoscopic Score (MES) of 0 or 1, is a target of treatment. The aim of our study was to evaluate the risk of clinical relapse between patients with an MES of 0 or 1 and determine if histologic activity using the Robarts Histopathologic Index (RHI) was predictive of clinical relapse. Methods UC patients with an MES score of 0 or 1, no prior colectomy, and at least 1 year of outpatient follow up after colonoscopy were included. Demographic, clinical characteristics, and clinical relapse were retrospectively collected. Biopsy specimens were read by a gastrointestinal pathologist. Primary outcome was defined as a composite of relapse requiring change in medical therapy, new steroid use, UC-related hospitalization, and/or colectomy. Results 445 UC patients were identified. 95% of patients with MES 0 were in histologic remission by the RHI whereas only 35% of patients with MES 1 were in histologic remission. 26% of patients experienced a clinical relapse; patients with MES 1 or RHI > 3 were significantly more likely to relapse (p<0.01) compared to patients with MES 0 or RHI ≤3. When patients were stratified into 4 groups (MES 0, RHI ≤3; MES 0, RHI > 3; MES 1, RHI ≤3; MES 1, RHI > 3) and adjusted for age and sex, RHI > 3 was predictive of relapse (p=0.008). Conclusion UC patients with endoscopic improvement have a high rate of clinical relapse over time. Histologic activity is a predictor of clinical relapse.

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Section: Discussioncontrasting

confidence: 99%

Histologic Inflammation can Predict Future Clinical Relapse in Ulcerative Colitis Patients in Endoscopic Remission

George,

Feldman,

Alizadeh

et al. 2023

Crohn's &Amp; Colitis 360

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PICaSSO virtual electronic chromendoscopy accurately reflects combined endoscopic and histological assessment for prediction of clinical outcomes in ulcerative colitis

et al. 2022

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Background and Aims A composite endoscopic‐histologic remission is increasingly explored as an important endpoint in ulcerative colitis (UC). We investigated combined endoscopic‐histologic remission for predicting clinical outcomes at 12 months compared with endoscopic remission alone using the high definition virtual chromoendoscopy (VCE) Paddington International virtual ChromoendoScopy ScOre (PICaSSO) and histology scores. Methods Ulcerative colitis patients, prospectively enrolled from 11 international centres, underwent VCE with targeted biopsies and followed up for 12 months. Endoscopic activity was assessed by Mayo Endoscopic Score (MES), Ulcerative Colitis Endoscopic Index Severity (UCEIS) followed by VCE‐PICaSSO. Robarts Histopathological Index|Robarts Histological index≤3 without neutrophils in mucosa, and Nancy Histological index (NHI)≤ 1 were used to define histologic remission. Combined endoscopic‐histologic remission was compared with endoscopic remission alone by Cox proportional hazards model and by two‐ and three‐proportion analysis using pre‐specified clinical outcomes. Results 307 patients were recruited and 302 analysed. There was no difference in survival without specified clinical outcomes between PICaSSO defined endoscopic remission alone and endoscopic plus histologic remission in the rectum (HR 0.42, 95%CI 0.16‐1.11 and HR 1.03, 95%CI 0.42‐2.52 for Robarts Histological index and NHI respectively) at 12 months. There was however a significant survival advantage without specified clinical outcome events for UCEIS combined with histology compared with UCEIS alone (HR 0.30, 95%CI 0.12‐0.75, p = 0.02) at 12 months (but not combined with NHI). For MES there was no advantage for predicting specified clinical outcomes at 12 months for endoscopy alone versus endoscopy plus histology, but there were differences in two and three proportion analysis at 6 months. Conclusion Endoscopic remission by VCE‐PICaSSO alone was similar to combined endoscopic and histologic remission for predicting specified clinical outcomes at 12 months. Larger studies with specific therapeutic interventions are required to further confirm the findings.

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Absence of Paneth Cell Metaplasia to Predict Clinical Relapse in Ulcerative Colitis with Endoscopically Quiescent Mucosa

Horiuchi,

Higashiyama,

Tahara

et al. 2024

Dig Dis Sci

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Histologic remission does not offer additional benefit for ulcerative colitis patients in endoscopic remission

Cited by 20 publications

References 35 publications

Histologic Inflammation can Predict Future Clinical Relapse in Ulcerative Colitis Patients in Endoscopic Remission

Histologic Inflammation can Predict Future Clinical Relapse in Ulcerative Colitis Patients in Endoscopic Remission

PICaSSO virtual electronic chromendoscopy accurately reflects combined endoscopic and histological assessment for prediction of clinical outcomes in ulcerative colitis

Absence of Paneth Cell Metaplasia to Predict Clinical Relapse in Ulcerative Colitis with Endoscopically Quiescent Mucosa

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