Histologic Remission (NANCY Index) is Superior to Endoscopic Mucosal Healing in Predicting Relapse Free Survival in Patients With Ulcerative Colitis in Clinical and Endoscopic Remission

Wang, Hunter; Fewings, Ingrid; Bornman, Lee; Shadbolt, Bruce; Fadia, Mitali; Subramaniam, Kavitha

doi:10.1097/mcg.0000000000001681

Cited by 15 publications

(9 citation statements)

References 55 publications

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“…Similar results were reported in a recently published study [ 43 ] of 184 UC patients with a median follow-up of 42 months. Patients with MES 0 and histologic remission (NHI 0) had significantly higher relapse-free rates of survival.…”

Section: Prognostic Values For Clinical Relapse Of Histological Scoressupporting

confidence: 91%

Considering Histologic Remission in Ulcerative Colitis as a Long-Term Target

Pavel,

Diculescu,

Stepan

et al. 2024

JCM

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Monitoring disease activity in inflammatory bowel disease (IBD) is challenging since clinical manifestations do not represent reliable surrogates for an accurate reflection of the inflammatory burden. Endoscopic remission had been the most significant endpoint target in the last years; nevertheless, a remarkable proportion of patients continue to relapse despite a normal-appearing mucosa, highlighting that endoscopy may underestimate the true extent of the disease. A subtle hint of the importance that histology plays in the long-term course of the disease has been endorsed by the STRIDE-II consensus, which recommends considering histologic healing for ulcerative colitis (UC), even though it is not stated to be a compulsory formal target. It is a continuum-changing paradigm, and it is almost a certainty that in the near future, histologic healing may become the new formal target for ulcerative colitis. It must be emphasized that there is great heterogeneity in defining histological remission, and the main criteria or cut-off values for inflammatory markers are still in an ill-defined area. The complexity of some histologic scores is a source of confusion among clinicians and pathologists, leading to low adherence in clinical practice when it comes to a homogenous histopathological report. Therefore, a standardized and more practical approach is urgently needed.

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Section: Prognostic Values For Clinical Relapse Of Histological Scoressupporting

confidence: 91%

Considering Histologic Remission in Ulcerative Colitis as a Long-Term Target

Pavel,

Diculescu,

Stepan

et al. 2024

JCM

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“…Despite endoscopic normalization, ongoing active histological activity may be associated with poorer clinical outcomes including higher clinical relapse rates, corticosteroid requirement, hospitalization, colectomy and development of colorectal neoplasia[ 3 - 7 ]. Although histological remission is currently not a formal treatment target by consensus expert-opinion, STRIDE-II guidelines do recommend that formal histological assessment take place to determine the depth of remission and help prognosticate patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

Knowledge and attitudes towards the use of histological assessments in ulcerative colitis by gastroenterologists vs pathologists

Pudipeddi¹,

Fung²,

Christensen³

et al. 2023

World J Gastroenterol

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BACKGROUND Histological remission is increasingly accepted as a treatment endpoint in the management of ulcerative colitis (UC). However, the knowledge of histology guidelines and the attitudes towards their use in clinical practice by gastroenterologists and pathologists is unknown. AIM To evaluate the knowledge of histology guidelines and attitudes towards the use of histology in UC by gastroenterologists and pathologists. METHODS A prospective, cross-sectional nationwide survey of gastroenterologists and pathologists who analyse UC specimens was conducted. The survey consisted of 34 questions to assess gastroenterologists’ and pathologists’ knowledge (score out of 19) and attitudes towards histological assessment in UC. Survey questions were formulated using the European Crohn’s and Colitis position paper on histopathology and the British Society of Gastroenterology biopsy reporting guidelines. It included knowledge of histological assessment of disease activity and dysplasia, knowledge of histological scoring systems for ulcerative colitis, uptake of histology scoring systems in routine practice, attitudes towards the role of histological activity, and the use of histological activity in clinical scenarios. RESULTS Of 89 responders (77 gastroenterologists, 12 pathologists), there was almost universal acceptance that histological assessment should form part of UC evaluation [95% gastroenterologists, 92% pathologists]. However, gastroenterologists reported that 92% of their pathologists do not use a histological scoring system. Utilisation of a formal histological scoring system was preferred by 77% of gastroenterologists and 58% of pathologists. Both groups lacked awareness of the Geboes Score, Nancy Index and Robarts Histopathological Index scoring systems with 91%, 87%, and 92% of gastroenterologists respectively; and 83%, 83%, and 92% pathologists respectively, being uncertain of scoring systems’ remission definitions. Histology knowledge score was not significantly different between gastroenterologists and pathologists [9/19 (IQR: 8-11) vs 8/19 (IQR: 7-10), P = 0.54]. Higher knowledge scores were predicted by hospital attending gastroenterologists ( P = 0.004), participation in inflammatory bowel disease (IBD) multidisciplinary teams ( P = 0.009), and self-declared IBD sub-specialist ( P = 0.03). CONCLUSION Histological remission is a recognised target for both gastroenterologists and pathologists. Despite this, knowledge of histological scoring systems and their utilisation is poor.

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“…Treatment outcome paradigms are shifting in recent years into establishment of deeper objective findings demonstrating complete healing of the bowel in patients with IBD. To date, adult guidelines suggest mucosal/endoscopic healing as the desirable target for patients with UC (3,4), but this may change in the near future given increased interest in the ability of histologic findings to predict disease outcomes, especially in patients without endoscopic inflammation (5,(11)(12)(13). While different histologic indices were developed in adults, they were not validated in pediatric patients.…”

Section: Discussionmentioning

confidence: 99%

“…The NHI was also shown to be an important feature that can predict outcomes in patients with IBD. Wang et al (5), for example, showed in UC patients with MES ≤ 1 that an NHI ≤ 1 was the only predictor of clinical relapse (29% vs 64%) during a median follow‐up of 42 months (hazard ratio 4.36, P = 0.002). In our study, 10 patients had complete mucosal healing, and 6 of them had concurrent histological remission (NHI = 0).…”

Section: Discussionmentioning

confidence: 99%

“…Currently, in agreement with the Selecting Therapeutic Targets in Inflammatory Bowel Disease‐II initiative, endoscopic remission is one of the desirable targets in adult patients with UC, and should guide therapeutic decisions (3,4). However, emerging data indicates that some UC patients with mucosal healing still exhibit histologic inflammation and have relatively worse outcomes, compared to patients with both endoscopic and histologic remission (5).…”

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confidence: 99%

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Correlation Between the Nancy Histopathology Index and Markers of Disease Activity in Pediatric Ulcerative Colitis

Faingelernt

Morgenstern

Matar

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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The Nancy Histological Index (NHI) was developed to assess histological disease activity in adult ulcerative colitis (UC) patients. However, data in pediatrics is limited. Our aim was to determine whether the NHI correlates with different indices of disease activity in pediatric UC patients. We retrospectively reviewed the NHI in rectal biopsies from 61 pediatric UC patients (median age 14.3 years), of whom 34 (55.7%) were newly diagnosed. The median Pediatric Ulcerative Colitis Activity Index (PUCAI) score among participants was 30 (interquartile range 5–55). Most patients exhibited an NHI of 3 (41/61, 67.2%) or 4 (8/61, 13.1%), reflecting moderate-severe histologic inflammation. A moderate positive correlation was identified between the NHI and PUCAI, fecal calprotectin, and Mayo endoscopic scores (r = 0.60, 0.54, and 0.56 respectively, P ≤ 0.001), but not with CRP or albumin. These results indicate that the NHI has a modest correlation with clinical, laboratory and endoscopic indices of disease activity in pediatric UC patients.

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Histologic Remission (NANCY Index) is Superior to Endoscopic Mucosal Healing in Predicting Relapse Free Survival in Patients With Ulcerative Colitis in Clinical and Endoscopic Remission

Cited by 15 publications

References 55 publications

Considering Histologic Remission in Ulcerative Colitis as a Long-Term Target

Considering Histologic Remission in Ulcerative Colitis as a Long-Term Target

Knowledge and attitudes towards the use of histological assessments in ulcerative colitis by gastroenterologists vs pathologists

Correlation Between the Nancy Histopathology Index and Markers of Disease Activity in Pediatric Ulcerative Colitis

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