Histological Markers of Clinical Relapse in Endoscopically Quiescent Ulcerative Colitis

Abstract

Background In ulcerative colitis (UC) patients who have achieved mucosal healing, active microscopic colonic mucosal inflammation is commonly observed. We aimed to assess the association between histological activity and disease relapse in endoscopically quiescent UC. Methods Ulcerative colitis patients with endoscopically quiescent disease and ≥12 months of follow-up were included. Biopsies were reviewed for the presence of basal plasmacytosis (BPC) and active histological inflammation, defined as a Geboes score (GS) ≥3.2. Primary outcome measures were disease relapse at 18 months and time to first relapse after index colonoscopy. Results Seventy-six UC patients (51% male; mean age, 38.6 years; median follow-up [range], 75.2 [2–118] months) were included. Sixty-two percent had an endoscopic Mayo score of 0 at index colonoscopy. Basal plasmacytosis was present in 46% and active histological inflammation in 30% of subjects. Presence of BPC was associated with a significantly shorter time to disease relapse (P = 0.01). Active histological inflammation was significantly associated with clinical relapse at 18 months (P = 0.0005) and shorter time to clinical relapse (P = 0.0006). Multivariate analysis demonstrated active histological inflammation to be independently associated with clinical relapse at 18 months and time to clinical relapse. Conclusions In endoscopically quiescent UC, active histological inflammation and the presence of BPC are adjunctive histological markers associated with increased likelihood of disease relapse. Although prospective studies are required, the presence of these histological markers should be a factor considered when making therapeutic decisions in UC.

Treatment Targets in Ulcerative Colitis: Is It Time for All In, including Histology?

“…Another angle is the evaluation of specific features; for example, in one of the early studies evaluating histological markers for active disease, the presence of basal plasmacytosis (BPC) was independently related to a higher risk of clinical relapse in patients with clinical remission, with an HR of 4.5–5.1 (95% CI 1.2–1.7 to 11.9–19.9) [ 98 , 103 ]. This result was confirmed by a more recent study; in 76 UC patients with endoscopically quiescent disease, presence of BPC and active histological inflammation (GS ≥ 3.2, OR 8.29 (95% CI 2.49–27.61)) were adjunctive histological markers associated with increased likelihood of disease relapse at 18 months follow-up [ 104 ].…”

Lower ultra-short-term heart rate variability is a risk factor for worse mucosal healing in ulcerative colitis

“…Endoscopically quiescent UC may still be histological active according to a previous clinical study [11]. Patients with a MES of 0 may still have a high risk of relapse if they have histological basal plasmacytosis [12]. Our rationale is that during mucosal healing, patients may realize the improvement of the symptoms and this subjective cognition of improvement may bring positive feedback on their HRV.…”

Common laboratory blood test immune panel markers are useful for grading ulcerative colitis endoscopic severity

“…The colonoscopy was conducted by an experienced physician and graded according to the Mayo Endoscopy Score (MES). Patients were divided into one of four grades on a 0–3 point scale: "MH" was defined as 0–1 points, and "EA" was defined as 2–3 points [ 19 ]. The extent of UC disease was classified by the extent of colonic involvement according to the Montreal classification as follows [ 20 ]: ulcerative proctitis (E1); left-sided colitis (E2); or extensive colitis (E3).…”