Histological healing after infliximab induction therapy in children with ulcerative colitis

Wiernicka, Anna; Szymańska, Sylwia; Cielecka-Kuszyk, Joanna; Dądalski, Maciej; Kierkuś, Jarosław

doi:10.3748/wjg.v21.i37.10654

Cited by 13 publications

(7 citation statements)

References 37 publications

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“…Data about the HR when using IFX are not so promising. D'haens et al [12] found that architectural alteration persisted in all adult UC patients reaching endoscopic remission under IFX, while significantly better results were obtained in pediatric UC patients [13]. Finally, we found that adult UC patients in deep remission under treatment with IFX failed to have a significant correlation with HR [6].…”

Section: Discussionsupporting

confidence: 51%

Histological Remission in Ulcerative Colitis in Deep Remission under Treatment with Adalimumab

Tursi

Nenna

Musci

et al. 2021

JGLD

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Background and Aims: Histological remission (HR) has been recently demonstrated as the last therapeutic goal in ulcerative colitis (UC), but it is unknown whether and how it may occur. Our aim was to assess the histology during the follow-up of an UC population in deep remission under treatment with adalimumab (ADA). Methods: We performed a retrospective study on 22 UC patients who were in deep remission and followed-up while receiving therapy with ADA. Colonoscopy in those patients was performed every year. Four-quadrant biopsies every 10 cm were obtained during each colonoscopy and assessed by hematoxylin and eosin stain. Histological activity was classified using the Geboes scale. Results: A total of 22 patients were enrolled in the study. The mean follow-up of those patients was 28±7 months, and 2,592 biopsy specimens in total were taken during 108 colonoscopies performed during the follow-up. At the beginning of the follow-up, histological inflammation was found in 15/22 (68.2%) of patients in deep remissio while receiving maintenance ADA therapy, 8/22 (36.4%) of them with Geboes score ≥3.1. At the end of the follow-up, when patients were still in deep remission while receiving maintenance ADA therapy, only 4 patients (18.2%) had at least one biopsy specimen with evidence of any histological inflammation during the follow-up; only two patients (9.1%) had Geboes score ≥3.1. Conclusions: Our study shows for the first time that UC patients in deep remission under ADA may reach HR, but it seems slower than other clinical or endoscopic goals.

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Section: Discussionsupporting

confidence: 51%

Histological Remission in Ulcerative Colitis in Deep Remission under Treatment with Adalimumab

Tursi

Nenna

Musci

et al. 2021

JGLD

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“…However, in our opinion, these elevated inflammatory markers in patients with quiescent IBD probably reflect ongoing IBD activity in the majority of patients. Indeed, many studies have shown that children and adults with IBD in clinical remission have ongoing inflammation on endoscopy [ 39 , 23 , 8 , 14 , 41 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

Relationship of clinical symptoms with biomarkers of inflammation in pediatric inflammatory bowel disease

et al. 2016

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In adult inflammatory bowel disease (IBD) patients, there is a strong discrepancy between symptoms and biomarkers of inflammation. Data on pediatric IBD patients are conflicting. Therefore, we aimed to investigate the relationship between clinical symptoms and biomarkers of inflammation in pediatric IBD. Patients aged <18 years with previously diagnosed Crohn’s disease (CD) or ulcerative colitis (UC) were included. Clinical disease activity was determined using the abbreviated Pediatric CD Activity Index (aPCDAI) or Pediatric UC Activity Index (PUCAI). Biochemical disease activity was assessed using fecal calprotectin (FC) and C-reactive protein (CRP). In total, 127 patients (62 male; median age 14.9 years) were included (82 CD, 45 UC). FC correlated weakly with total aPCDAI score (rs = 0.32; 95 % CI 0.12–0.51; p = 0.003) and total PUCAI score (rs = 0.36; 95 % CI 0.07–0.62; p = 0.015). Only aPCDAI components abdominal examination and perirectal disease and PUCAI component activity level had a significant correlation with levels of FC. CRP correlated weakly with total aPCDAI score (rs = 0.28; 95 % CI 0.05–0.46; p = 0.012) and aPCDAI components abdominal examination and activity level. No significant correlation was observed between CRP and total PUCAI score (rs = 0.01; 95 % CI −0.34–0.29; p = 0.961) or individual PUCAI components.Conclusion: There is a strong discrepancy between clinical symptoms and biomarkers of inflammation in children with IBD. What is Known: • A substantial proportion of asymptomatic pediatric inflammatory bowel disease (IBD) patients have elevated biomarkers of inflammation.• There is a strong discrepancy between symptoms and biomarkers of inflammation in adults with IBD. What is New: • Clinical symptoms are only weakly associated with levels of fecal calprotectin and serum C-reactive protein in children and adolescents with previously diagnosed IBD.• Similarly to adult IBD patients, there is a strong discrepancy between clinical symptoms and biomarkers of inflammation in children with IBD.Electronic supplementary materialThe online version of this article (doi:10.1007/s00431-016-2762-2) contains supplementary material, which is available to authorized users.

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“…Over the past decades, >30 histological scores have been developed, although their adoption in clinical practice remains modest 11 12. Similarly, different definitions and criteria of HR have been proposed, ranging from ‘elimination of mucosal ulceration/erosion’ to ‘complete histological normalisation’ 1 3 13–18. Almost all investigators now agree that the absence of neutrophilic infiltration (‘neutrophil-free’ mucosa) is the key to a HR definition due to its association with favourable clinical outcomes 2 4 5 19–22.…”

Section: Introductionmentioning

confidence: 99%

PICaSSO Histologic Remission Index (PHRI) in ulcerative colitis: development of a novel simplified histological score for monitoring mucosal healing and predicting clinical outcomes and its applicability in an artificial intelligence system

Gui

Bazarova

Amor

et al. 2022

Gut

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Histological remission is evolving as an important treatment target in UC. We aimed to develop a simple histological index, aligned to endoscopy, correlated with clinical outcomes, and suited to apply to an artificial intelligence (AI) system to evaluate inflammatory activity.MethodsUsing a set of 614 biopsies from 307 patients with UC enrolled into a prospective multicentre study, we developed the Paddington International virtual ChromoendoScopy ScOre (PICaSSO) Histologic Remission Index (PHRI). Agreement with multiple other histological indices and validation for inter-reader reproducibility were assessed. Finally, to implement PHRI into a computer-aided diagnosis system, we trained and tested a novel deep learning strategy based on a CNN architecture to detect neutrophils, calculate PHRI and identify active from quiescent UC using a subset of 138 biopsies.ResultsPHRI is strongly correlated with endoscopic scores (Mayo Endoscopic Score and UC Endoscopic Index of Severity and PICaSSO) and with clinical outcomes (hospitalisation, colectomy and initiation or changes in medical therapy due to UC flare-up). A PHRI score of 1 could accurately stratify patients’ risk of adverse outcomes (hospitalisation, colectomy and treatment optimisation due to flare-up) within 12 months. Our inter-reader agreement was high (intraclass correlation 0.84). Our preliminary AI algorithm differentiated active from quiescent UC with 78% sensitivity, 91.7% specificity and 86% accuracy.ConclusionsPHRI is a simple histological index in UC, and it exhibits the highest correlation with endoscopic activity and clinical outcomes. A PHRI-based AI system was accurate in predicting histological remission.

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Histological healing after infliximab induction therapy in children with ulcerative colitis

Abstract: IFX has a positive histological effect in more than one-third of UC patients. IFX reduces intestinal inflammation and improves clinical condition.

Cited by 13 publications

References 37 publications

Histological Remission in Ulcerative Colitis in Deep Remission under Treatment with Adalimumab

Histological Remission in Ulcerative Colitis in Deep Remission under Treatment with Adalimumab

Relationship of clinical symptoms with biomarkers of inflammation in pediatric inflammatory bowel disease

PICaSSO Histologic Remission Index (PHRI) in ulcerative colitis: development of a novel simplified histological score for monitoring mucosal healing and predicting clinical outcomes and its applicability in an artificial intelligence system

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