scholarly journals OP28 Gene expression (GE) values in a phase 2 trial of mirikizumab in ulcerative colitis (UC) correlate better with histopathology (HP) than endoscopy (EN) and Mayo scores

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S025-S026
Author(s):  
B Steere ◽  
K GOTTLIEB ◽  
J Schmitz ◽  
R Higgs ◽  
B Jia ◽  
...  
Keyword(s):  
Gene Expression ◽  
Ulcerative Colitis ◽  
Simulation Analysis ◽  
Mucosal Healing ◽  
P Value ◽  
Pathway Network ◽  
Phase 2 Trial ◽  
Mayo Score ◽  
Index Of Severity ◽  
Regulated Gene Expression

Abstract Background HP is considered integral to the definition of mucosal healing of UC. The regulated transcription of genes determines cell identity and function, and, consequentially, HP and EN appearance. Here we correlate GE in a UC clinical trial with EN and HP indices, and the modified Mayo score (MMS). Methods 249 patients. with moderately-to-severely active UC were randomised to placebo or different doses of mirikizumab, a p19-directed IL-23 antibody (NCT02589665). Gene expression in baseline biopsy samples from the most affected area in the colon was evaluated using Affymetrix HTA2.0 exon-format microarray with a typical Bioconductor workflow (DOI: 10.1186/gb-2004-5-10-r801). Genes were represented by their largest groups of highly correlated exon groups. Expression values were correlated with Robart‘s Histopathology Index (RHI), Geboes score (GS), Ulcerative Colitis Endoscopic Index of Severity (UCEIS), and modified Mayo score (MMS) at baseline. A threshold of false-discovery rate (FDR)-adjusted p-value ≤0.05 was applied to the significance of the r-values. Subsets of genes of interest were subjected to pathway enrichment using MetaCore (Clarivate Analytics). Simulation analysis (SIM) was performed to estimate any bias in correlation estimates caused by the number of levels used for different clinical scores. Results The plot (Figure 1) shows more genes with expression values that correlate significantly (q < 0.05) with RHI (4647), than UCEIS (1232), or MMS (869) (refer to legend). There are 498 genes that intersect all scores, representing predominantly the pathways/networks in Table 1. The RHI covers 86 % (1064/1232) of the genes that correlate with UCEIS. The genes unique to the UCEIS (168) do not significantly map to a specific pathway/network. Highest absolute r-values were RHI 0.56, GS 0.45, UCEIS 0.4 and MMS 0.3. The corresponding lowest q values expressed in −Log10 are 15, 9, 4, and 2.5. SIM shows only a minimal bias of <0.03 units (Pearson’s and Spearman’s r). Conclusion In our analysis, RHI tracked baseline gene expression values best, followed by another HP index (GS), followed by EN (UCEIS) and finally MMS. Judging by the orders-of-magnitude greater significance of correlation with gene expression values, the histology indices are particularly information-rich. Regulated gene expression, fundamental to a phenotypic appearance in HP, seems to best mirrored by the RHI, followed by GS. The genes that track with all indices predominantly modulate cell adhesion and leukocyte trafficking. The genes that are unique to the UCEIS, compared with the RHI, do not significantly belong to any recognisable pathway or network. Further evaluation of what current EN scores contribute relative to HP disease activity assessment in UC may be useful.

scholarly journals P148 Reproducibility of PICaSSO score by using narrow banding images (NBI) to assess mucosal and histological healing in ulcerative colitis (UC) patients

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S211-S212 ◽  
Author(s):  
R Cannatelli ◽  
O Nardone ◽  
U Shivaji ◽  
S C L Smith ◽  
A Bazarova ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Roc Curves ◽  
Mucosal Healing ◽  
Operating Characteristics ◽  
Mayo Score ◽  
Endoscopic Remission ◽  
Histological Activity ◽  
Index Of Severity ◽  
Virtual Chromoendoscopy ◽  
Sensitivity Specificity

Abstract Background The endoscopic and histological healing are key therapeutic targets in ulcerative colitis(UC) patients. PICaSSO (Paddington International virtual ChromoendoScopy ScOre)1,2 is a new Virtual Chromoendoscopy Endoscopic (VCE) score to better define mucosal healing by mucosal and vascular features. Originally validated using iSCAN platform, the aim of this study was to evaluate the reproducibility of PICaSSO with NBI near focus platform and to assess if this could predict histological healing. Methods We prospectively studied 78 UC patients (mean age 43.4 years, 52.6% male) who underwent colonoscopy for colitis assessment or surveillance using NBI near focus (Olympus, Japan). Endoscopic activity was assessed by using ulcerative colitis Endoscopic Index of Severity (UCEIS) and PICaSSO; whilst histological activity was scored by the Robarts Histology Index (RHI). ROC curves were performed to evaluate sensitivity, specificity and accuracy of endoscopy scores to predict histological healing. Results Out of 78 patients, 47 (60.3%) were in clinical remission according to the partial Mayo score. 28(35.9%) and 32(41.0%) were in endoscopic remission according to UCEIS≤1 and PICaSSO≤3, respectively. The best cut-off of UCEIS to predict histological healing was less or equal to 1. Sensitivity, specificity and accuracy were 84.6% (95% CI 63.5, 96.4), 88.5% (95% CI 70.1, 97.8) and 87.2% (95% CI 75.6, 93.6), respectively. The Area Under the ROC curve (AUROC) was 93.3% (95% CI 88.2, 98.3). The best threshold of PICaSSO in the prediction of histological healing was less or equal to 3. PICaSSO ≤ 3 have sensitivity of 96.2% (95% CI 76.9, 100), specificity of 86.5% (95% CI 67.3, 96.2) and accuracy of 89.7% (95% CI 77.6, 96.2) to predict histological healing, estimated as RHI ≤ 3. The AUROC was 95.3% (95% CI 91.1, 99.5). Conclusion PICaSSO VCE score can be easily and accurately reproduced with NBI near focus platform and it has better operating characteristics than UCEIS to predict histological healing defined by RHI. Reference

scholarly journals Effectiveness of treatment of moderate ulcerative colitis with prolonged mesalazine in real clinical practice

2021 ◽  
pp. 144-151
Author(s):  
O. V. Knyazev ◽  
A. V. Kagramanova ◽  
A. A. Lishchinskaya
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Remission ◽  
Topical Therapy ◽  
Fecal Calprotectin ◽  
Mucosal Healing ◽  
Prolonged Release ◽  
Mayo Score ◽  
Endoscopic Remission ◽  
Oral Mesalazine ◽  
High Doses

Introduction. Ulcerative colitis (UC) is one of the severe therapeutic diseases. High doses of oral granular mesalazine are required to maintain clinical and endoscopic remission of UC, which may be sufficient and supposedly more acceptable for patients, as some studies showed that adherence to topical therapy is significantly lower than to oral 5-ASA drugs.Objective of the study. To evaluate the efficacy of therapy of patients with moderate left-sided ulcerative colitis (UC) and pancolitis receiving prolonged-release ethylcellulose-coated mesalazine.Materials and methods. The evaluation of the outcomes of treatment of UC patients who received prolonged-release mesalazine was carried out. We examined 87 patients with UC who received granular ethylcellulose-coated mesalazine, of those 38 (43.7%) men and 49 (56.3%) women. The average age of the enrolled patients was 38.3 ± 12.6 years.Results and discussion. After 2 weeks from the beginning of therapy with prolonged-release mesalazine, the majority of patients – 71 (81.6%) responded to the therapy. After 12 weeks, 71 (81.6%) of 87 UC patients, who responded to therapy with prolongedrelease mesalazine, remained in clinical remission. On average, the Mayo score in the group decreased from 7.6 ± 0.99 to 2.6 ± 0.25 points. There was a significant decrease in CRP, ESR, leukocytosis, and fecal calprotectin. After 26 weeks, Mayo score in the group of patients remained on average at the level of 2.2–2.3 points. The number of UC patients with colon mucosal healing was 32 (36.8%) patients. A year after the start of therapy with prolonged-release mesalazine, 69 (79.3%) UC patients who responded to therapy had a clinical remission, of those 32 (36.8%) patients had a clinical and endoscopic remission. During the year of observation, no case of surgical intervention or re-hospitalization due to exacerbation of the disease was recorded in patients with UC who achieved remission.Conclusions. Treatment of moderate active UC should begin with oral mesalazine ≥ 3 g per day in combination with topical mesalazine. The prolonged-release mesalazines are the most preferred

scholarly journals P227 Defining faecal calprotectin thresholds to predict endoscopic and histological healing in ulcerative colitis (UC) by using advanced optical enhancement techniques

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S255-S256
Author(s):  
R Cannatelli ◽  
D Zardo ◽  
O Nardone ◽  
A Bazarova ◽  
U Shivaji ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Surrogate Marker ◽  
Scoring Systems ◽  
Roc Curves ◽  
Mucosal Healing ◽  
Faecal Calprotectin ◽  
Area Under Roc Curve ◽  
Index Of Severity ◽  
Sensitivity Specificity ◽  
A Prospective Study

Abstract Background Faecal calprotectin (FC) is the most common surrogate marker of mucosal healing (MH) in UC. A number of endoscopic and histologic scoring systems in UC have been developed for defining MH. We report the optimum FC thresholds for defining MH using all the assessment methods. Methods In a prospective study we collected all clinical, endoscopic and histologic data and FC from 76 UC patients (mean age 44.2y, 50.0% male) who attended endoscopy unit for colitis assessment or surveillance. Endoscopic scores were determined by the same endoscopist (MI) and included Mayo Endoscopic Score (MES), Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and PICaSSO (Paddington International virtual ChromoendoScopy ScOre). Histological activity was scored by the Robarts Histology Index (RHI) and Nancy Index by the same pathologist (DZ). Faecal calprotectin was assayed using Buhlmann faecal turbo test, particle enhanced turbidimetric immunoassay. ROC curves were performed to evaluate sensitivity, specificity and accuracy of the optimum cut-off of FC to predict endoscopic and histological healing. Results The best cut-off for FC to predict endoscopic healing calculated as Picasso≤3 was 161 μg/g with Area Under ROC curve (AUROC) of 85.3% (95% CI 76.2, 94.4). Sensitivity, specificity and accuracy were 87.9% (95% CI 57.6, 100), 76.7% (95% CI 53.5, 90.7) and 81.6% (95% CI 68.4, 89.5), respectively. While, the best threshold of FC to predict UCEIS≤1 was 148 μg/g with AUROC of 89.2 (95% CI 81.9, 96.5). Sensitivity was 93.5% (95% CI 50.5, 100), specificity 82.2% (95% CI 53.3, 91.1) and accuracy 86.8% (95% CI 69.7, 92.1). The best threshold for FC to predict MES equal to 0, was 112 μg/g, with AUROC of 89.6 μg/g, (95% CI 82.5, 96.7). Sensitivity, specificity and accuracy were 89.7%ww (95% CI 39.2, 100), 85.1% (95% CI 55.3, 93.6) and 86.9% (95% CI 68.4, 92.1), respectively. The best value of FC to predict histological healing with RHI≤3 was 112μg/g with AUROC of 88.0% (95% CI 80.6, 95.4). Sensitivity, specificity and accuracy were 88.5% (95% CI 53.8, 100), 80.0% (95% CI 62.0, 90.0) and 82.9% (95% CI 72.5, 89.5), respectively. When used Nancy≤1 FC cut-off to predict healing was 172 μg/g with AUROC of 87.1% (95% CI 78.6, 95.6). Sensitivity was 96.4% (95% CI 60.7, 100), specificity 72.9% (54.2, 85.4) and accuracy 81.6% (69.7, 89.5). Conclusion Advanced enhancement technologies can accurately define the level of FC to predict endoscopic and histological healing in UC. The optimum FC threshold for MH by PICaSSO and by Nancy was similar (161 and 172 μg/g respectively), while the FC threshold for mucosal healing by MES and by RHI was 112 μg/g. The FC threshold for determining MH in clinical practice should be lower than at least 200 μg/g.

scholarly journals P225 Using a standardised reporting proforma is associated with improved endoscopic assessment in UC

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S255-S255
Author(s):  
R KADER ◽  
P Middleton ◽  
O Ahmad ◽  
R Dart ◽  
J McGuire ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Disease Activity ◽  
Site Factors ◽  
Multi Centre Study ◽  
Gi Endoscopy ◽  
Mayo Score ◽  
Chi Squared ◽  
Index Of Severity ◽  
Level Of Training ◽  
Endoscopic Assessment

Abstract Background Repeated endoscopic assessments are an essential part of ulcerative colitis (UC) disease management and current guidelines recommend the use of an endoscopic activity score, either the endoscopic Mayo score or Ulcerative Colitis Endoscopic Index of Severity (UCEIS) as treatment targets. These indices have prognostic value, with endoscopic healing associated with favourable short- and long-term outcomes. This multi-centre study aimed to assess the frequency of using endoscopic disease activity scores in UC patients undergoing lower GI endoscopy. Methods Lower GI endoscopy reports from patients with UC were retrospectively reviewed from 7 sites in London between April and October 2018. Endoscopy reports were assessed based on the BRIDGe endoscopic reporting criteria including the use of Mayo or UCEIS score. The comparison was made between site factors (specialist IBD centres/non-specialist centres, use of reporting proforma), endoscopist speciality (gastroenterology, surgery or nurse endoscopist), level of training (consultant, registrar or nurse endoscopist) and interest in IBD. Chi-squared was used to compare groups. Results 899 lower GI endoscopy reports were reviewed. Mayo or UCEIS was used in 51% of cases (453/899). The use of endoscopic scores were significantly higher in gastroenterologists than in surgeons and nurse endoscopists respectively (401/762 (53%) vs. 22/54 (41%) vs. 30/83 (36%)), and higher in registrar trainees than consultants and nurse endoscopists (175/251 (70%) vs. 248/565 (44%) vs. 30/83 (36%)) and in those with a specialist interest in IBD compared with those without (237/409 (58%) vs. 216/490 (44%), p < 0.0001). The use of endoscopic scores was more frequent in specialist IBD centres than in non-specialist centres (417/728 (58%) vs. 36/172 (21%), p < 0.001). One centre used a reporting proforma which was associated with a significantly higher frequency of score use compared with centres without a proforma (202/260 (78%) vs. 251/639 (39%), p < 0.0001). Conclusion Reporting of endoscopic disease activity using a standardised scoring system occurs in only half of cases from this large multi-centre cohort. Frequency of use is higher in specialist IBD centres and when performed by gastroenterology specialists. Endoscopy reports from a site that used a standardised reporting proforma were significantly more likely to include an endoscopic index as well as a range of other reporting items. This suggests, at least in part, that endoscopy reporting may be optimised by the introduction of a proforma. Integration of a standardised proforma into reporting software would target all endoscopists performing UC endoscopies regardless of speciality, site or IBD interest.

scholarly journals MODERATE TO SEVERE ENDOSCOPIC INFLAMMATION IS FREQUENT AFTER ACHIEVING CLINICAL REMISSION IN PEDIATRIC ULCERATIVE COLITIS

2021 ◽  
Vol 27 (Supplement_1) ◽  
pp. S13-S13
Author(s):  
Chen Sarbagili-Shabat ◽  
Dror Weiner ◽  
Joram Wardi ◽  
Lee Abramas ◽  
Michal Yaakov ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Remission ◽  
Residual Disease ◽  
Activity Index ◽  
Final Analysis ◽  
Mucosal Healing ◽  
Sustained Remission ◽  
High Relapse Rate ◽  
Mayo Score

Abstract Background Pediatric ulcerative colitis (UC) is characterized by low sustained remission rates and frequent extension of disease even if clinical remission is obtained with therapy. Moderate to severe endoscopic activity is a risk factor for relapse while evidence regarding early mucosal healing or persistence of inflammation after remission in children is not available. Our aim was to evaluate if persistence of significant inflammation is common and could explain the high relapse rate in pediatric UC. Methods Pediatric UC patients with clinical remission, defined as pediatric UC activity index (PUCAI) scores < 10, were prospectively assessed for mucosal healing by endoscopy 3–5 months after remission was documented. Mayo score was assessed for each segment by a blinded adult gastroenterologist using central reading. Symptomatic patients prior to sigmoidoscopy were excluded Sustained remission was assessed retrospectively at 18 months follow-up. Results Forty-six children were enrolled, 28 children in continuous clinical remission at time of sigmoidoscopy were included in the final analysis. Mayo 0 was present in 12/28 (42.86%), Mayo 1 in 2/28 (7.1%) and Mayo 2–3 in 14/28 (50.0%) endoscopies. Among 23/28 patients with follow-up through 18 months, remission was sustained in 2/11 (18.18%) of patients with Mayo 2 and 3 versus 6/12 (50.0%) with Mayo score 0–1. Conclusion Over 50% of children assessed for mucosal healing 3–5 months after clinical remission is obtained have residual disease activity, primarily moderate to severe inflammation which was associated with lower sustained remission. Early sigmoidoscopy after clinical remission for assessment of mucosal disease should be considered in pediatric UC.

scholarly journals Molecular Signature of Persistent Histological Inflammation in Ulcerative Colitis with Mucosal Healing

2020 ◽  
Vol 29 (2) ◽  
pp. 159-166
Author(s):  
Mircea Manuc ◽  
Elena Mirela Ionescu ◽  
Elena Milanesi ◽  
Maria Dobre ◽  
Ioana Tieranu ◽  
...  
Keyword(s):  
Gene Expression ◽  
Ulcerative Colitis ◽  
Pearson Correlation ◽  
Mucosal Healing ◽  
Formyl Peptide Receptor ◽  
Molecular Signature ◽  
Expression Levels ◽  
Endoscopic Remission ◽  
Formyl Peptide ◽  
Gene Expression Levels

Background and Aims: Therapeutic targets in ulcerative colitis (UC) have evolved over time from clinical remission to biological and endoscopic remission. Histologic remission remains a debatable outcome due to lack of data regarding its impact on long-term evolution. The development of histologic activity scores has brought standardization. We aimed to identify mucosal markers differentiating histological inflammation from histological remission in UC patients. Methods: The gene expression levels of 84 genes associated with inflammatory bowel diseases have been analyzed in 43 colonic mucosa samples from 30 patients with UC. The gene expression levels have been correlated with histological inflammation score of Geboes. Patients with endoscopic remission were divided by histological activity into two groups and molecular results were compared in order to identify differences in the mucosal gene expression. Results: We found a significant Pearson correlation (p<0.001 and r>0.5) between the Geboes score and the expression of 29 genes, whereas negative correlation (p<0.001 and r<-0.50) was observed with two genes in the entire UC cohort. In the subgroup of patients with endoscopic remission three transcripts: formyl-peptide receptor 1 (FPR1), matrix metalloproteinases 1 (MMP1) and mucine 1 (MUC1) were significantly up-regulated in patients with histological inflammation compared to patients with histologic remission. Conclusion: Our study further emphasizes the importance of histological assessment when endoscopic mucosal healing is present, as FPR1, MMP-1 and MUC1 were all significantly upregulated in patients with histological alterations.

scholarly journals Long-term, Real-life, Observational Study in Treating Outpatient Ulcerative Colitis with Golimumab

2021 ◽  
Author(s):  
Antonio Tursi ◽  
Giammarco Mocci ◽  
Walter Elisei ◽  
Leonardo Allegretta ◽  
Raffaele Colucci ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Response ◽  
Clinical Remission ◽  
Real Life ◽  
Mucosal Healing ◽  
Term Treatment ◽  
Short Term Treatment ◽  
Mayo Score

Background and Aims: Several studies have found Golimumab (GOL) effective and safe in the short-term treatment of ulcerative colitis (UC), but few long-term data are currently available from real world. Our aim was to assess the long-term real-life efficacy and safety of GOL in managing UC outpatients in Italy. Methods: A retrospective multicenter study assessing consecutive UC outpatients treated with GOL for at least 3-month of follow-up was made. Primary endpoints were the induction and maintenance of remission in UC, defined as Mayo score ≤2. Several secondary endpoints, including clinical response, colectomy rate, steroid free remission and mucosal healing, were also assessed during the follow-up. Results: One hundred and seventy-eight patients were enrolled and followed up for a median (IQR) time of 9 (3-18) months (mean time follow-up: 33.1±13 months). Clinical remission was achieved in 57 (32.1%) patients: these patients continued with GOL, but only 6 patients (3.4%) were still under clinical remission with GOL at the 42nd month of follow-up. Clinical response occurred in 64 (36.4%) patients; colectomy was performed in 8 (7.8%) patients, all of them having primary failure. Steroid-free remission occurred in 23 (12.9%) patients, and mucosal healing was achieved in 29/89 (32.6%) patients. Adverse events occurred in 14 (7.9%) patients. Conclusions: Golimumab does not seem able to maintain long-term remission in UC in real life. The safety profile was good.

P077 A NEW TREATMENT APPROACH FOR INFLAMMATORY BOWEL DISEASE: INTRACOLONIC BIFIDOBACTERIUM AND XYLOGLUCAN APPLICATION

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S35-S36
Author(s):  
Hüseyin Bozkurt
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Mucosal Healing ◽  
Single Administration ◽  
Diagnostic Strategies ◽  
Bifidobacterium Animalis ◽  
Mayo Score ◽  
Before And After ◽  
Inflammatory Bowel

Abstract Background Inflammatory bowel disease (IBD) pathogenesis includes the altered gut microbiota, environmental factors, human immune responses and genetic. Reduced bifidobacteria level is associated with IBD. Xyloglucan is a plant based prebiotic oligosaccharide. Bifidobacteria level is increased in the presence of xyloglucan. In this article we aim to share the results of our cases; Ulcerative colitis (UC) patients treated by intracolonic single administration of Bifidobacterium animalis subsp. lactis and Xyloglucan combination. Methods Ten UC patients were evaluated; before and after intracolonic single administration of Bifidobacterium animalis subsp. lactis and Xyloglucan combination with colonoscopic laboratory and clinical examination. Results Age, sex, diagnosis, disease location, previous medications are summarized in Table 1. All the patients had active ulcerative colitis disease before the administration. The Mayo Score was used to assess the severity of UC. 2 cases had extensive colitis and 8 patients had left-sided colitis. After 6 weeks of the administration mucosal healing and resolution of colonic symptoms were seen. These results are summarized in Table 2. Of the 10 cases, 7 were undertaken 5-ASA +Azathiopurine and three were undertaken vedolizumab treatment. Intracolonic single Bifidobacterium animalis subsp. lactis and xyloglucan administration was found effective in the mucosal healing and resolution of colonic symptoms in ulcerative colitis patients. Conclusions Herein we reported the importance of Bifidobacterium and xylooligosaccharide combination in IBD. Colonoscopic single Bifidobacterium animalis subsp. lactis and xyloglucan administration is a new method that has no side effect and easy to apply for treatment of IBD.This application might provide enhancement of non-stimulatory status and higher biodiversity in colonic mucosa so mucosal healing may be improved rapidly. However, it would be necessary to develop diagnostic strategies in order to discriminate which patients would benefit from this strategy.

Sa1125 GENE EXPRESSION (GE) VALUES IN A PHASE 2 TRIAL OF MIRIKIZUMAB IN ULCERATIVE COLITIS (UC) CORRELATE BETTER WITH HISTOPATHOLOGY (HP) THAN ENDOSCOPY (EN) AND MAYO SCORES

2020 ◽  
Vol 158 (6) ◽  
pp. S-284-S-285
Author(s):  
Boyd Steere ◽  
Klaus Gottlieb ◽  
Jochen Schmitz ◽  
Richard Higgs ◽  
Bochao Jia ◽  
...  
Keyword(s):  
Gene Expression ◽  
Ulcerative Colitis ◽  
Phase 2 ◽  
Phase 2 Trial

scholarly journals Histological Markers of Clinical Relapse in Endoscopically Quiescent Ulcerative Colitis

2019 ◽  
Vol 26 (11) ◽  
pp. 1722-1729 ◽  
Author(s):  
David Kevans ◽  
Richard Kirsch ◽  
Callum Dargavel ◽  
Boyko Kabakchiev ◽  
Robert Riddell ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Mucosal Healing ◽  
Mucosal Inflammation ◽  
Clinical Relapse ◽  
Disease Relapse ◽  
Mayo Score ◽  
Therapeutic Decisions ◽  
First Relapse ◽  
Histological Activity

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.

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