Mucosal Healing in Ulcerative Colitis – When Zero is Better

Carvalho, Pedro Boal; Castro, Francisca Dias de; Rosa, Bruno; Moreira, Maria João; Cotter, José

doi:10.1093/ecco-jcc/jjv180

Cited by 79 publications

(66 citation statements)

References 48 publications

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“…Importantly, we observed that achieving histologic remission may be most relevant in patients who have mild endoscopic activity, whereas its benefit in patients who achieve complete endoscopic remission may have less impact on shorter terms outcomes, requiring a longer time horizon of follow up to identify benefit. However, prior studies have demonstrated benefit of achieving histologic remission, even in patients who achieve complete endoscopic remission 12‐16 . These differences may be related to variability in patient characteristics including the proportion of patients with high‐and low‐risk disease and the accuracy of diagnosing MES 0 vs MES 1 in different studies.…”

Section: Discussionmentioning

confidence: 99%

Predictors and outcomes of histological remission in ulcerative colitis treated to endoscopic healing

Jangi

Yoon

Dulai

et al. 2020

Aliment Pharmacol Ther

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Summary Background Clinical remission is the recommended treatment target in ulcerative colitis. The predictors and outcomes of achieving histologic remission within a treat‐to‐target paradigm are not well established. Aim To evaluate the predictors and outcomes of achieving histologic remission in patients with ulcerative colitis treated‐to‐target of endoscopic healing (modified Mayo endoscopy score 0 or 1). Methods We conducted a retrospective cohort study in adults with active ulcerative colitis (modified Mayo endoscopy score 2 or 3), whose treatment was iteratively optimised to achieve endoscopic healing. We identified predictors of achieving histologic remission, and outcomes (risk of symptomatic relapse, and ulcerative colitis‐related hospitalisation and/or surgery) of achieving histologic remission vs persistent histologic activity, using Cox proportional hazard analysis. Results Of the 411 patients with clinically active ulcerative colitis, 270 achieved endoscopic healing. Of the 270 patients, 55% simultaneously achieved histologic remission. Depth of endoscopic healing at final endoscopic assessment was the only independent determinant of histologic remission (modified Mayo endoscopy score 0 vs 1: odds ratio, 0.31 [95% confidence intervals, 0.18‐0.52]). Over 28 months, achieving histologic remission was associated with a lower risk of clinical relapse (1‐year cumulative risk: 18.7% vs 29.5%; adjusted hazard ratio, 0.56 [0.37‐0.85]), and lower risk of hospitalisation (hazard ratio, 0.44 [0.20‐0.94]). The incremental benefit of achieving histologic remission was observed only in patients achieving Mayo endoscopy score 1, but not Mayo endoscopy score 0. Conclusions In patients with active ulcerative colitis treated‐to‐target of endoscopic healing, 55% simultaneously achieved histologic remission. Histologic remission, particularly in patients achieving modified Mayo endoscopy score 1, was associated with favourable outcomes. Treating to a target of histologic remission over endoscopic healing requires prospective evaluation.

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Section: Discussionmentioning

confidence: 99%

Predictors and outcomes of histological remission in ulcerative colitis treated to endoscopic healing

Jangi

Yoon

Dulai

et al. 2020

Aliment Pharmacol Ther

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“…Our results show a difference in transcription between the Mayo endoscopic score (MES) of 0 and 1. Previous papers have shown that a MES of 0 gives a favorable outcome in relation to clinical remission rates [17][18][19]. All genes that were differentially transcribed were up-regulated in MES 1.…”

Section: Discussionmentioning

confidence: 82%

Mucosal gene transcription of ulcerative colitis in endoscopic remission

Arkteg

Goll

Gundersen

et al. 2020

Scandinavian Journal of Gastroenterology

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Aim/Objective: Ulcerative colitis (UC) is a chronic inflammatory bowel disease. In UC, a wide range of criteria are used for disease remission, with few studies investigating the differences between disease remission and normal control groups. This paper compares known inflammatory and healing mediators in the mucosa of UC in clinical remission and normal controls, in order to better describe the remission state. Method: Mucosal biopsies from 72 study participants (48 UC and 24 normal controls) were included from the Advanced Study of Inflammatory Bowel Disease (ASIB Study), Arctic University of Norway, Norway. Clinical remission was defined as Mayo clinical score 2, with endoscopic subscores of 1. Targeted gene transcription analyses were performed using hydrolysis probes and SYBR-green. Results: Among the mucosal transcripts examined, 10 genes were regulated in remission versus normal controls, 8 upregulated pro-inflammatory transcripts (IL1B, IL33, TNF, TRAF1, CLDN2, STAT1, STAT3 and IL13Ra2) and 2 downregulated (pro-inflammatory TBX21 and anti-inflammatory TGFB1). In total, 14 transcripts were regulated between the investigated groups. Several master transcription factors for Tcell development were upregulated in patients with Mayo endoscopic score of 1 in comparison to 0. Conclusions: The mucosa of UC in clinical and endoscopic remission differs from normal mucosa, suggesting a remaining dysregulation of inflammatory and wound healing mechanisms.

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“…Our novel imaging-enhanced endoscopic system with MAGIC score could become one of the non-invasive, objective and quantitative modalities for detailed evaluation of MH in patients with UC. Recently, endoscopic evaluation of UC disease activity has become more important and essential because the treatment goal for UC has shifted from controlling symptoms during clinical remission to achieving endoscopic remission, i. e. MH [26]; however, the term MH is considered ambiguous because there is no validated definition of MH in UC patients for either endoscopic or histologic examinations. MES is widely used to evaluate endoscopic disease activity in clinical practice and trials, because it is easy to assess, and an MES of 0 or 1 is often defined as MH; however, several studies have demonstrated a wide difference in the UC relapse rate between patients with MES 0 and those with MES 1 [7,8].…”

Section: Discussionmentioning

confidence: 99%

A novel endoscopic imaging system for quantitative evaluation of colonic mucosal inflammation in patients with quiescent ulcerative colitis

et al. 2020

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Background and study aims Mucosal healing (MH) is associated with clinical outcome in ulcerative colitis (UC) patients. In most clinical trials, a Mayo endoscopic subscore (MES) of 0 or 1 is defined as MH. However, several recent studies have reported that clinical outcome is different between UC patients with MES 0 and those with MES 1. In addition, the MES is subjective and may differ among endoscopists. Therefore, a repeatable and objective scoring system is required to distinguish MES 0 from MES 1, even in clinically quiescent UC. Here, we assessed the usefulness of new image-enhancing endoscopic technology, the i-scan TE-c, to quantitatively evaluate colonic inflammation in patients with quiescent UC. Methods We retrospectively reviewed the data from 52 UC patients in clinical remission who had undergone routine colonoscopy with standard white light. The white-light images were reassessed using the new system, and the degree of colonic mucosal inflammation was quantified according to the MAGIC (Mucosal Analysis of Inflammatory Gravity by i-scan TE-c Image) score. We used the i-scan TE-c system to investigate the association among the MAGIC score, MES, and histologic activity (Geboes score). Results The MAGIC score was significantly higher in the MES 1 group than in the MES 0 group (P = 0.0034). The MAGIC score significantly correlated with the Geboes score (P = 0.015). Conclusions Our novel image-enhancing endoscopic system was useful for objective and quantitative evaluation of MH in patients with quiescent UC. Further clinical studies using this imaging system are required to confirm its clinical benefit for the management of UC patients.

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Mucosal Healing in Ulcerative Colitis – When Zero is Better

Cited by 79 publications

References 48 publications

Predictors and outcomes of histological remission in ulcerative colitis treated to endoscopic healing

Predictors and outcomes of histological remission in ulcerative colitis treated to endoscopic healing

Mucosal gene transcription of ulcerative colitis in endoscopic remission

A novel endoscopic imaging system for quantitative evaluation of colonic mucosal inflammation in patients with quiescent ulcerative colitis

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