scholarly journals P270 Ulcerative colitis disease extent and inflammatory burden assessment: DUBLIN and modified Nancy score

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S285-S286
Author(s):  
J C Rocha Silva ◽  
J Rodrigues ◽  
A Rodrigues ◽  
A Silva ◽  
C Fernades ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Score ◽  
Mucosal Inflammation ◽  
Clinical Relapse ◽  
Disease Extent ◽  
Faecal Calprotectin ◽  
Protein Levels ◽  
Mayo Score ◽  
Disease Extension ◽  
Inflammatory Burden

Abstract Background Current endoscopic activity scores for ulcerative colitis (UC) do not take into account the extent of mucosal inflammation. The DUBLIN score (Degree of Ulcerative Colitis Burden of Luminal Inflammation) is a simple bedside clinical score that estimates inflammatory burden using both disease severity and extent, which correlates with objective inflammatory markers and is associated with clinical outcomes. The validated Nancy score is used to evaluate histological activity; nonetheless, it does not take in consideration disease extension. We aimed to evaluate the relation of both Mayo and Dublin scores with disease activity and as predictive factors of clinical relapse. Also, we developed a modified Nancy score in order to assess histologic activity considering disease extension. Methods A retrospective cohort study, which consecutively included all UC patients submitted to colonoscopy with biopsies between 2016 and 2019 in our unit. Mayo and DUBLIN scores were calculated. Modified Nancy score was calculated as a product of Nancy Score and disease extent (E1-E3). Correlation of both endoscopic and histologic scores with biomarkers, relapse (in a 6months) and relapse-free time as performed. Results 107 patients were selected, 52.3% (n = 56) male, mean age = 48.4 ± 13.9 years. Mean Dublin score was 2.65 ± 2.75. Mayo and DUBLIN scores presented good correlation (r = 0.880, p < 0.001). Also Dublin score correlated with modified Nancy score (p < 0.001). Both Dublin score (p = 0.009) and modified Nancy score (p = 0.026) correlated with C-reactive protein levels. Nancy score correlated with faecal calprotectin (p = 0,025). Relapse occurred in 26.2% (n = 28) of patients with a mean time for the event of 13 ± 7 weeks. Mayo Score (p < 0.001), Dublin score (p < 0.001), Nancy score (p < 0.001) and modified Nancy score (p < 0.001) presented a significant association with relapse. Areas under the ROC curve were 0.786 for Dublin score, 0.751 for Mayo score, 0.84 for Nancy score and 0.79 for modified Nancy score. Conclusion DUBLIN and modified Nancy scores correlate with each other and with biomarkers and are independent predictors of relapse. Dublin score was superior to Mayo score in the prediction of relapse.

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.

Clinical Predictors of Response to Faecal Microbiota Transplantation in Patients with Active Ulcerative Colitis

2020 ◽  
Author(s):  
Ajit Sood ◽  
Arshdeep Singh ◽  
Ramit Mahajan ◽  
Vandana Midha ◽  
Kirandeep Kaur ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Mayo Clinic ◽  
Clinical Remission ◽  
Active Ulcerative Colitis ◽  
Faecal Microbiota ◽  
Disease Extent ◽  
Faecal Microbiota Transplantation ◽  
Mayo Score ◽  
Predictors Of Response ◽  
Younger Age

Abstract Background Faecal microbiota transplantation [FMT] has been shown to be effective for induction of remission in patients with active ulcerative colitis [UC]. At present, the clinical factors impacting the response to FMT in UC remain unclear. Methods Patients with active UC treated with multisession FMT via colonoscopy at weeks 0, 2, 6, 10, 14, 18 and 22 were analysed. Response to FMT was defined as achievement of corticosteroid-free clinical remission at week 30. Patient and disease characteristics were evaluated to determine the predictors of response to FMT. Results Of 140 patients with active UC treated with FMT, 93 (mean age 34.96 ± 11.27 years, 62.36% males [n = 58], mean Mayo clinic score 8.07 ± 2.00) who completed the multisession FMT protocol were analysed. Fifty-seven [61.29%] patients achieved clinical remission. Younger age (odds ratio [OR] for age 0.93, 95% confidence interval [CI] 0.89–0.97, p = 0.001), moderate [Mayo clinic score 6–9] disease severity [OR 3.01, 95% CI 1.12–8.06, p = 0.025] and endoscopic Mayo score 2 [OR 5.55, 95% CI 2.18–14.06, p < 0.001] were significant predictors of remission on univariate analysis. Younger age, disease extent E2 and endoscopic Mayo score 2 [OR 0.925, 95% CI 0.88–0.97, p = 0.002; OR 2.89, 95% CI 1.01–8.25, p = 0.04; and OR 8.43, 95% CI 2.38–29.84, p = 0.001, respectively] were associated with clinical remission on multivariate logistic regression. A mathematical model [nomogram] was developed for estimating the probability of remission with the FMT protocol. Conclusion Younger age, disease extent E2 and endoscopic Mayo score 2 significantly predict achievement of clinical remission with FMT in active UC. The prediction model can help in selecting individuals for FMT. Validation in larger cohorts is needed.

Comparison of the Nancy Index With Continuous Geboes Score: Histological Remission and Response in Ulcerative Colitis

2020 ◽  
Vol 14 (7) ◽  
pp. 1021-1025 ◽  
Author(s):  
Fernando Magro ◽  
Joanne Lopes ◽  
Paula Borralho ◽  
Cláudia Camila Dias ◽  
Joana Afonso ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Correlation Coefficient ◽  
Area Under The Curve ◽  
Clinical Relapse ◽  
Strongly Correlated ◽  
Histological Response ◽  
Faecal Calprotectin ◽  
Histological Activity ◽  
Histological Remission

Abstract Background and Aims Evidence has been supporting that histological activity of ulcerative colitis [UC] has relevance for the prediction of clinical outcomes in UC patients, such as clinical relapse. In this study, we aimed to compare two histological indexes—the continuous Geboes score [GS] and the Nancy index [NI] —regarding their definitions of histological remission and response, and to determine the ability of faecal calprotectin [FC] levels to discriminate between these histological statuses according to the NI. Methods A large cohort of UC patients [N = 422] who were previously enrolled in other studies was analysed. Results GS and NI were shown to be strongly correlated [correlation coefficient: 0.882, p <0.001], indicating high accordance in the classification of patients as having/not having histological remission and response. FC levels moderately correlated with NI regarding these histological statuses [correlation coefficient: 0.481, p <0.001], moderately predicted the absence of remission defined by NI >0 {area under the curve (AUC) 0.667 (95% confidence interval [CI] 0.609–0.724)}, and were good predictors of the absence of histological response defined by NI >1 (AUC 0.825 [95% CI 0.777–0.872]). The optimal FC cut-offs determined to predict the NI-defined histological remission and response were 91 μg/g and 106 μg/g, when maximising the negative predictive value [NPV]. Conclusions Due to the higher applicability of the NI, this study encourages the systematic use of this histological index to assess histological remission and response in UC patients.

scholarly journals Soluble human Suppression of Tumorigenicity 2 is associated with endoscopic activity in patients with moderate-to-severe ulcerative colitis treated with golimumab

2019 ◽  
Vol 12 ◽  
pp. 175628481986914
Author(s):  
Fernando Magro ◽  
Susana Lopes ◽  
Marco Silva ◽  
Rosa Coelho ◽  
Francisco Portela ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Therapeutic Response ◽  
Clinical Activity ◽  
Open Label ◽  
Faecal Calprotectin ◽  
Reactive Protein ◽  
Mayo Score ◽  
Histological Activity ◽  
Median Change ◽  
Multicentre Prospective Study

Background: Suppressor of Tumorigenicity 2 (ST2) is an IL33 receptor detected in the mucosa and serum of ulcerative colitis (UC) patients. We evaluated soluble ST2 (sST2) as a surrogate biomarker of disease outcome and therapeutic response, in moderate-to-severe UC patients treated with golimumab. Methods: We conducted an open-label single-arm multicentre prospective study. At screening/baseline, week 6 (W6) and week 16 (W16), clinical and endoscopic activity (total Mayo score), histologic activity (Geboes index) and biomarkers were evaluated. Results: From 38 patients, 34 (89.5%) completed W6 and 29 (76.3%) completed W16. Mean age (±SD) was 34.6 ± 12.6 years; 55.9% were female. At W16, 62.1% achieved clinical response. Patients with endoscopic activity at W6 ( n = 20) had higher baseline sST2 (median, 24.5 versus 18.7 ng/ml, p = 0.026) and no decrease from baseline (median change, 0.8 versus −2.7, p = 0.029). At W6, sST2 levels correlated with endoscopic activity ( rs = 0.45, p = 0.007) but not with histological activity ( rs = 0.25, p = 0.151). The best cut-offs for endoscopic activity were sST2 = 16.9 ng/ml (sensitivity = 85%; specificity = 71%) and faecal calprotectin (FC) = 353 μg/g (sensitivity = 90%, specificity = 67%). Patients with histological activity at W6 ( n = 27) had higher baseline ST2 levels (median, 23.0 versus 13.7 ng/ml, p = 0.035). sST2 did not correlate with FC or serum C-reactive protein. FC levels correlated with histological activity and baseline FC were higher when Geboes ⩾3.1 at W6. Conclusions: sST2 may be a surrogate biomarker of UC activity and therapeutic response as it correlates with endoscopic and clinical activity at W6 of golimumab treatment, and subjects with endoscopic and histological activity at W6 had higher baseline ST2 levels.

scholarly journals P122 High correlation between faecal calprotectin and a Novel Integral Index for evaluating disease activity in ulcerative colitis patients

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S197-S197
Author(s):  
J K Yamamoto-Furusho ◽  
E A Mendieta-Escalante
Keyword(s):  
Ulcerative Colitis ◽  
Disease Activity ◽  
Intestinal Inflammation ◽  
Activity Index ◽  
P Value ◽  
The Novel ◽  
Integral Index ◽  
Full Spectrum ◽  
Faecal Calprotectin ◽  
Mayo Score

Abstract Background Ulcerative colitis (UC) is a chronic and incurable disease characterised by periods of activity and remission. There are several indexes that evaluate the UC activity from clinical, biochemical and endoscopic parameters. The faecal calprotectin is a non-invasive marker for detecting intestinal inflammation in UC patients. A new novel integral disease index (Yamamoto-Furusho index) includes clinical, biochemical, endoscopic and histological findings that evaluate the full spectrum of activity in UC patients. The aim is to correlate the Novel Index Activity index (Yamamoto-Furusho Index) with faecal calprotectin levels in UC patients and compare with other indexes. Methods A total of 158 patients with confirmed diagnosis of UC from the IBD Clinic were recruited in the period between July 2017 and June 2019. All demographic and clinical characteristics were collected from clinical charts. The faecal calprotectin was measured at least 1 week before the colonoscopy and biopsies. The Spearman’s Rho was used for the correlation. A p-value of <0.05 was considered as significant. Results We analysed 185 patients with UC, 85 patients (51.8%) were women and 73 (44.5%) men, with an average current age of 43.53 years (+14.35), an age at diagnosis of 36.6 + 15.1 years and disease duration of 11.27 ± 8.1 years. The extension was distributed on proctitis (E1) in 13.3%, left colitis (E2) in 19.6% and pancolitis (E3) in 31.6%. The treatment was based on mesalazine in 93.9%, steroids in 26.2% and azathioprine in 15.9%. The correlation between faecal calprotectin and the Yamamoto–Furusho index was high (rho = 0.730, p < 0.0001) compared with other indexes such as endoscopic Mayo sub-score (rho = 0.705, p = <0.001); Truelove–Witts (rho = 0.644, p = <0.001), Full Mayo score (rho = 0.708, p = <0.001) and Montreal (rho = 0.551, p = <0.001). Conclusion The novel integral index showed a high correlation with faecal calprotectin compared with other UC indexes for evaluating disease activity in UC patients.

Histological Inflammation in the Endoscopically Uninflamed Mucosa is Associated With Worse Outcomes in Limited Ulcerative Colitis

2021 ◽  
Author(s):  
Catarina Geraldes de Frias Gomes ◽  
Alexandra Sofia Ribeiro de Almeida ◽  
Catarina Callé Lucas Mendes ◽  
Pierre Ellul ◽  
Johan Burisch ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Confidence Interval ◽  
Retrospective Cohort ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Newly Diagnosed ◽  
Disease Extent ◽  
Treatment Naïve ◽  
Disease Extension

Abstract Background The Montreal classification categorizes patients with ulcerative colitis (UC) based on their macroscopic disease extent. Independent of endoscopic extent, biopsies through all colonic segments should be retrieved during index colonoscopy. However, the prognostic value of histological inflammation at diagnosis in the inflamed and uninflamed regions of the colon has never been assessed. Methods This was a multicenter retrospective cohort study of newly diagnosed patients with treatment-naïve proctitis and left-sided UC. Biopsies from at least 2 colonic segments (endoscopically inflamed and uninflamed mucosa) were retrieved and reviewed by 2 pathologists. Histological features in the endoscopically inflamed and uninflamed mucosa were scored using the Nancy score. The primary outcomes were disease complications (proximal disease extension, need for hospitalization or colectomy) and higher therapeutic requirements (need for steroids or for therapy escalation). Results Overall, 93 treatment-naïve patients were included, with a median follow-up of 44 months (range, 2-329). The prevalence of any histological inflammation above the endoscopic margin was 71%. Proximal disease extension was more frequent in patients with histological inflammation in the endoscopically uninflamed mucosa at diagnosis (21.5% vs 3.4%, P = 0.04). Histological involvement above the endoscopic margin was the only predictor associated with an earlier need for therapy escalation (adjusted hazard ratio, 3.69; 95% confidence interval, 1.05-13.0); P = 0.04) and disease complications (adjusted hazard ratio, 4.79; 95% confidence interval, 1.10-20.9; P = 0.04). Conclusions The presence of histological inflammation in the endoscopically uninflamed mucosa at the time of diagnosis was associated with worse outcomes in limited UC.

scholarly journals P146 Comparison of three histologic indices in ulcerative colitis: Evaluation from the Phase 2 study of upadacitinib (U-ACHIEVE)

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S210-S211
Author(s):  
V Jairath ◽  
W J Lee ◽  
W Zhou ◽  
G Heap ◽  
J Butler ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Disease Activity ◽  
Financial Support ◽  
Missing Values ◽  
Mucosal Inflammation ◽  
Controlled Study ◽  
Physician Global Assessment ◽  
Double Blind ◽  
Faecal Calprotectin ◽  
Reactive Protein

Abstract Background Several histologic indices are available for evaluating mucosal inflammation activity in ulcerative colitis (UC), although there is no consensus regarding which is the most appropriate for evaluating disease activity in clinical trials. Methods The correlation of three histologic indices, the Geboes Score (GS, range of major grade 0 to 5), Robarts Histopathology Index (RHI, range 0 to 33), and Nancy Index (NI, range grade 0 to grade 4) were evaluated in a Phase 2b, multicenter, randomised, double-blind, placebo-controlled study of upadacitinib in patients with moderately to severely active UC. Biopsy data were collected and centrally read using GS at Baseline and week 8; scores of RHI1 and NI2 were derived based on GS. Descriptive statistics, correlational analyses, and stratified analyses were performed in the pooled study population using as observed data. Results Among 250 UC patients enrolled at Baseline, 224, 214, 209 patients with non-missing values of GS, RHI and NI were observed, respectively. At week 8, the GS, RHI, and NI correlated strongly to each other (r = 0.90 to 0.98), and these 3 indices correlated highly with the subgrade of lamina propria neutrophils, erosion or ulceration, neutrophils in the epithelium, and chronic inflammatory infiltrate (Table 1). The Mayo endoscopic subscore (r = 0.62) was found to have higher correlation with GS, RHI and NI, followed by physician global assessment subscore (r = 0.48 to 0.51), rectal bleeding subscore (r = 0.36 to 0.39) and stool frequency subscore (r = 0.31 to 0.33). Faecal calprotectin (r = 0.47 to 0.50) and C-reactive protein (0.36 to 0.39) and total IBDQ score (r = 0.34 to 0.38) were moderately correlated with GS, RHI, and NI. Over 50% of patients with Mayo endoscopic subscore ≤1 were observed among patients scoring GS = 0 (24/41, 59%), GS = 1 (8/15, 53%), GS = 2 (13/26, 50%), RHI≤3 (45/82, 55%), and NI = 0 (40/69, 58%) at week 8. Conclusion In a moderately to severely active UC population, GS, RHI and NI correlate strongly with each other. Higher correlations were found between histologic scores and endoscopic activity than symptom-related disease activity. Further studies are warranted to evaluate the relationship between histological inflammation and long-term clinical outcomes. References Acknowledgements and Funding statement: Design, study conduct, and financial support for the study were provided by AbbVie; Financial support for the study was provided by AbbVie. AbbVie participated in interpretation of data, review, and approval of the abstract. All authors contributed to development of the abstract and maintained control over final content.

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