Usefulness of Different Pathological Scores to Assess Healing of the Mucosa in Inflammatory Bowel Diseases: A Real Life Study

Abstract

The concept of remission for patients with inflammatory bowel diseases has recently evolved, and should also include histological healing of the mucosa, difficult to evaluate since there is no agreement on pathological scores and those available are quite complex to use in the daily routine. We evaluated the possible usefulness of a simplified pathological score to assess histological healing of the mucosa in inflammatory bowel diseases patients compared with four commonly proposed pathological scores. Slides from 24 patients (12 Crohn’s disease, 12 ulcerative colitis, age range 24–62 years), pre- and post-treatment with biological agents and displaying endoscopic remission were assessed by two pathologists. Pre- and post-treatment results and the time employed to calculate the various scores were obtained. All scores were useful to document highly significant post-treatment decreases of histological activity. However, the simplified score needed significant less time to be calculated for each slide, had high inter-rater agreement, and avoided subjectivity from the pathologists. The simplified score is easy to calculate and seems apt to document histological healing of the mucosa, in a manner similar to the more complex scores. It remains to be established whether this score could simplify the daily routinary practice in this context.

Histological scoring systems in ulcerative colitis patients: a routine practice perspective

“…Of the numerous histological scoring systems that have been proposed for IBD evaluation, only a few have been validated. More to that, it is the opinion of gastrointestinal pathology experts 6 that, due to their complexity, they are generally more suited for scientific purposes and are difficult to use in routine practice. In some scores, particular aspects of the scoring process imply a high level of subjectivity and they usually take considerable time for assessing.…”

“…Villanacci 6 also aimed at developing a simple, less time-consuming scoring system, which would be more appropriate for routine practice. For assessment it is essential to be provided by the endoscopist with two samples from each colonic segment and terminal ileum.…”

Histologic Features with Predictive Value for Outcome of Patients with Ulcerative Colitis

“…Complete remission of all lesions can be identified in about one quarter of patients [42]. There are some controversies about the degree of basal plasmacytosis that is acceptable in a patient with histologic healing, since plasma cells are not an indicator of disease activity [25]. Since basal plasmacytosis is, by itself, a poor prognosis marker, we consider that a true histologic healing has no basal plasmacytosis.…”

“…Recently, some other promising scores for UC have been validated and used in current practice, the most prominent being Nancy and Robarts Indexes [23,24]. They have a good reproducibility and a wider accessibility, but they still need validation as predictive tools for UC [25]. Nancy Index assesses, in a sequential form, the presence of ulceration, acute inflammatory infiltrate (presence of neutrophils and eosinophils in lamina propria and in epithelium) and chronic inflammatory infiltrate, using a semi-qualitative scale very easy to understand, which allows a great reproducibility [23].…”

“…From all features with predictive value, histologic healing offers the best chance to maintain a sustained remission of the disease [25,41]. It is, probably, the best indicator of treatment efficacy and the most logical moment for stopping maintenance therapy [44].…”