Histological Risk Factors to Predict Clinical Relapse in Ulcerative Colitis With Endoscopically Normal Mucosa

Ozaki, Ryo; Kobayashi, Taku; Okabayashi, Shinji; Nakano, Masaaki; Morinaga, Soichiro; Hara, Atsuko; Ohbu, Makoto; Matsuoka, Katsuyoshi; Toyonaga, Takahiko; Saito, Eiko; Hisamatsu, Tadakazu; Hibi, Toshifumi

doi:10.1093/ecco-jcc/jjy092

Cited by 71 publications

(66 citation statements)

References 31 publications

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“…In comparison, in the MES‐0 group, our endocytoscopic cutoff value (histological Geboes score ≥ 3.1; indicating the persistence of neutrophils in the epithelium and crypt destruction, erosion and/or ulceration) could not accurately predict clinical relapse. Our results were consistent with previous histological studies: in their MES‐0 group, Ozaki et al 26 reported no significant differences leading up to clinical relapse regarding crypt abscess or Nancy histological index ≥ 2 (indicating the persistence of neutrophil infiltrate and/or ulceration). Cushing et al 27 reported that the Geboes score cutoff value predicting clinical relapse was >0, not ≥3.1.…”

Section: Discussionsupporting

confidence: 93%

Endocytoscopic intramucosal capillary network changes and crypt architecture abnormalities can predict relapse in patients with an ulcerative colitis Mayo endoscopic score of 1

Maeda

Kudo

Ogata

et al. 2020

Digestive Endoscopy

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Objectives Recent studies have suggested the necessity of therapeutic intervention for patients with ulcerative colitis at high risk of clinical relapse with a Mayo endoscopic score (MES) of 1. The aim of this retrospective cohort study was to demonstrate the impact of intramucosal capillary network changes and crypt architecture abnormalities to stratify the risk of relapse in patients with an MES of 1. Methods All included patients had an MES of ≤1 and confirmed sustained clinical remission between October 2016 and April 2019. We classified patients with an MES of 1 as “intramucosal capillary/crypt (ICC)‐active” or “ICC‐inactive” using endocytoscopic evaluation. We followed patients until October 2019 or until relapse; the main outcome measure was the difference in clinical relapse‐free rates between ICC‐active and ICC‐inactive patients with an MES of 1. Results We included 224 patients and analyzed data for 218 (82 ICC‐active and 54 ICC‐active with an MES of 1 and 82 with an MES of 0). During follow‐up, among the patients with an MES of 1, 30.5% (95% confidence interval 20.8–41.6; 25/82) of the patients relapsed in the ICC‐active group and 5.6% (95% confidence interval 1.2–15.4; 3/54) of the patients relapsed in the ICC‐inactive group. The ICC‐inactive group had a significantly higher clinical relapse‐free rate compared with the ICC‐active group (P < 0.01). Conclusions In vivo intramucosal capillary network and crypt architecture patterns stratified the risk of clinical relapse in patients with an MES of 1 (UMIN 000032580; UMIN 000036359).

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Section: Discussionsupporting

confidence: 93%

Endocytoscopic intramucosal capillary network changes and crypt architecture abnormalities can predict relapse in patients with an ulcerative colitis Mayo endoscopic score of 1

Maeda

Kudo

Ogata

et al. 2020

Digestive Endoscopy

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“…21 However, other published studies that have suggested that histologic activity is a predictor of poor outcomes in those with endoscopically normal appearing mucosa. 7,16,17,22 Two of these studies included patients who had Mayo endoscopic subscores of 0 or 1, therefore, the findings from these studies may not apply to patients who achieve completely normal endoscopic appearance (Mayo endoscopic subscore 0). 16,22 Patients with mild endoscopic activity (Mayo endoscopic subscore 1) are likely to have histologic activity and more likely to relapse compared to patients with a Mayo endoscopic subscore of 0.…”

Section: Discussionmentioning

confidence: 99%

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

Narula

Aruljothy

Alshahrani

et al. 2020

Aliment Pharmacol Ther

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SummaryBackgroundHistologic remission in ulcerative colitis (UC) patients may be associated with positive outcomes. It is unclear whether UC patients in endoscopic remission obtain additional benefit from achieving histologic remission.AimTo evaluate the relationship between time to relapse and histological activity among UC patients in endoscopic remission.MethodsIn this retrospective study using an observational database, we identified UC patients who had achieved endoscopic remission (Mayo endoscopic subscore 0). Index colonoscopy was the first colonoscopy when endoscopic remission was achieved. Histologic activity was classified as normal, inactive or active colitis. The primary outcome was time to relapse. Secondary outcomes included reasons for relapse and the association between baseline variables and risk of relapse. A Cox proportional hazards model evaluated baseline factors and the outcome of relapse.ResultsWe included 269 patients. The Kaplan‐Meier survival curve showed no significant difference between the presence or absence of histologic activity and time to relapse (log rank P = 0.85). There was no difference in time to clinical relapse of patients with histologically active colitis compared to inactive colitis (adjusted hazard ratio [AHR] 1.17, 95% CI 0.58‐2.32, P = 0.67]). 5‐aminosalicylate use (AHR 0.42, 95% CI 0.21‐0.82, P = 0.011), pancolitis (AHR 0.32, 95% CI 0.13‐0.75, P = 0.008), left‐sided colitis (AHR 0.46; 95% CI 0.22‐0.98; P = 0.044) and older age (AHR 0.96, 95% CI 0.94‐0.99, P = 0.002) were significantly associated with reduced time to clinical relapse.ConclusionHistologic remission did not influence time to relapse in UC patients who had achieved endoscopic remission.

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“…Few studies have shown that histological healing as a target of therapy is associated with better outcomes, even in patients with mucosal healing . Moreover, ongoing histological activity may be associated with increased disease relapse rates in patients with endoscopically normal mucosa . A few previous studies have shown conflicting results on the relationship between endoscopic and histological activity due to the use of heterogeneous, nonvalidated endoscopic and histological indices …”

Section: Discussionmentioning

confidence: 99%

“…However, endoscopic inactivity does not always correlate with histological inactivity . Ongoing histological activity may be associated with the increased risk of disease relapse, even in patients with endoscopically normal mucosa . Moreover, histological inflammation has also been shown to be associated with increased risk of dysplasia in patients with UC .…”

Section: Introductionmentioning

confidence: 99%

Relationship between Mayo endoscopic score and histological scores in ulcerative colitis: A prospective study

et al. 2019

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Background The Mayo endoscopic score (MES) remains the most commonly used index in clinical practice, as well as in various clinical trials. Recently, two validated histological indices (Nancy Index [NI] and Robert Histological Index [RHI]) have been developed for ulcerative colitis (UC). We aim to study the relationship between MES with NI, RHI, and the established Geboes Index (GI) in patients with UC. Methods This was a prospective single‐center study. MES was documented from the most involved area. Biopsy was taken from the same area and reported by a single gastrointestinal histopathologist who was blinded to the endoscopic score. Histological activity was reported using GI, NI, and RHI. Statistical analysis was performed using Spearman's correlation coefficient and Cohen's kappa coefficient using SPSS version 23. Results Median age of patients with UC (n = 96) was 36 years. Seventeen patients were in endoscopic remission (MES 0/1). Correlation coefficient between MES and GI/NI/RHI was only weak to moderate (rho = 0.381/0.389/0.442, respectively; P < 0.001 for all three correlations). In patients with endoscopic mucosal healing (n = 17), the agreement coefficient between MES and GI/RHI was weak (κ = 0.253/0.336, respectively; P = 0.001 for both agreements). However, there was no significant agreement coefficient between MES and NI (P = 0.573). Conclusion MES moderately correlated with histological scores. RHI had the best correlation with MES among all histological indices. Endoscopic mucosal healing is not strongly correlated with histological healing. Histological examination should be performed even in patients with mucosal healing to detect ongoing histological activity.

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Histological Risk Factors to Predict Clinical Relapse in Ulcerative Colitis With Endoscopically Normal Mucosa

Abstract: Mucin depletion was shown to be a histological risk factor for clinical relapse in UC patients with MES 0.

Cited by 71 publications

References 31 publications

Endocytoscopic intramucosal capillary network changes and crypt architecture abnormalities can predict relapse in patients with an ulcerative colitis Mayo endoscopic score of 1

Endocytoscopic intramucosal capillary network changes and crypt architecture abnormalities can predict relapse in patients with an ulcerative colitis Mayo endoscopic score of 1

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

Relationship between Mayo endoscopic score and histological scores in ulcerative colitis: A prospective study

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