Assessment of Histological Remission in Ulcerative Colitis: Discrepancies Between Daily Practice and Expert Opinion

Römkens, Tessa E H; Kranenburg, P.; Tilburg, Arjan van; Bronkhorst, Carolien; Nagtegaal, Irıs D.; Drenth, Joost P.H.; Hoentjen, Frank

doi:10.1093/ecco-jcc/jjx165

Cited by 30 publications

(22 citation statements)

References 45 publications

(49 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Comparative trials revealed a strong correlation between Geboes score, Nancy index and Robarts score suggesting that the available validated scores may provide overlapping data. Instead, a study by Römkens et al showed that the correlation between the nonvalidated scores and between the nonvalidated and validated scores was moderate, highlighting how the histologic score can influence patient management and therapeutic decisions. Dosage of FC levels was performed through different methods and the most commonly adopted test was ELISA.…”

Section: Discussionmentioning

confidence: 99%

Review article: faecal calprotectin and histologic remission in ulcerative colitis

D’Amico

Bonovas

Danese

et al. 2020

Aliment Pharmacol Ther

View full text Add to dashboard Cite

Summary Background Histologic healing is emerging as a new therapeutic goal in both routine practice and clinical trials in ulcerative colitis (UC). However, it requires repeated endoscopies and biopsies. Faecal calprotectin is a non‐invasive marker of mucosal healing (endoscopic and histologic healing). Aim To conduct a systematic review to clarify the correlation between faecal calprotectin levels and histologic activity in UC patients. Methods We searched PubMed/MEDLINE, EMBASE and Web of Science through September 2019 to identify studies in patients with confirmed diagnosis of UC, reporting the correlation between faecal calprotectin levels and histologic analysis. Results Twelve studies enrolling 1168 patients were included in the final review. Histologic remission was defined according to nonvalidated scores in five articles and using partially validated scores in seven articles. Faecal calprotectin values were measured in 6 of 12 studies (50%) with the same kit, while the remaining six studies adopted individually different kits. A clear correlation between faecal calprotectin levels and histology was showed in all included studies. Eleven different faecal calprotectin cut‐off points were identified to distinguish histological remission from histological activity, ranging from 40.5 to 250 μg/g. Conclusions Faecal calprotectin can be used to predict histologic remission in patients with UC, but the cut‐off level varies across studies, according to the test used to measure this biomarker and according to the definition of histologic remission. Larger prospective studies using validated histologic indexes are needed to identify a globally accepted faecal calprotectin cut‐off level to discriminate between histologic remission and histologically active disease.

show abstract

Section: Discussionmentioning

confidence: 99%

Review article: faecal calprotectin and histologic remission in ulcerative colitis

D’Amico

Bonovas

Danese

et al. 2020

Aliment Pharmacol Ther

View full text Add to dashboard Cite

show abstract

“…To maximally decrease the variability in the histological scoring, we recommend extensive training and the application of scoring conventions in clinical practice for those histopathologists that use the incorporate histological scoring for UC. 5,24 Finally, our study might have implications for the development of new endoscopic tools.…”

Section: Accepted Manuscriptmentioning

confidence: 89%

Variability in the Distribution of Histological Disease Activity in the Colon of Patients with Ulcerative Colitis

Bossuyt

Bisschops

Vermeire

et al. 2020

Journal of Crohn's and Colitis

View full text Add to dashboard Cite

Objective Histological activity scores were developed and validated. Data on the distribution of the histological inflammation within one segment in patients with ulcerative colitis (UC) are lacking. This impacts on the reliability of the histological activity scores. The aim of this study was to assess the variability in histological activity within one endoscopic segment in patients with UC. Design Biopsies were taken in sequential patients with UC in 3 adjacent contiguous regions within a macroscopically homogeneous colonic segment. Biopsies were scored for Geboes score (GS), Robarts histological index (RHI) and Nancy histological index (NHI). Variability was assessed by Kappa statistics for categorical outcomes and intraclass correlation coefficient (ICC) for continuous outcomes. Results A total of 161 biopsy sets from 55 endoscopic segments of 21 patients were analysed. Endoscopic active disease was present in 45% of segments. The continuous histological scores showed excellent agreement between the different regions. The ICC for RHI in all segments was 0.974 (95% confidence interval (CI) 0,958 - 0,984;p <0.0001) and 0.98 (95% CI: 0,968 -0,988;p <0.0001) for the numerically converted GS. The categorical NHI showed higher variability: κ=0.574 (95% CI: 0.571-0.577;p <0.0001). In all segments the highest variability was seen in samples with NHI=2. When dichotomizing based on histologic remission, substantial agreement was seen for all scores, with κ>0.734 for all cut-offs. The homogeneity in the distribution of the histological disease activity was comparable between the colonic segments. Conclusion Distribution of histological disease activity in UC follows a homogeneous pattern in different locations of one segment.

show abstract

“… 5 Additionally, one of the main clinical aims in UC treatment is continuous maintenance of mucosal healing in patients with UC. 6 Nowadays, mucosal healing can be maintained for 12 months with continued application of immunosuppressive drugs and biological agents, but aggravation of colon inflammation is inevitable when treatment stops. 3 Accordingly, new noninvasive markers and therapeutic approaches for monitoring and maintaining mucosal healing in patients with UC should be defined.…”

Section: Introductionmentioning

confidence: 99%

Indoleamine 2,3-dioxygenase-dependent expansion of T-regulatory cells maintains mucosal healing in ulcerative colitis

Acović

Marković

Gazdic

et al. 2018

Therap Adv Gastroenterol

View full text Add to dashboard Cite

Background:Dendritic cell (DC)-derived indolamine 2,3-dioxygenase (IDO) degrades tryptophan to kynurenine, which promotes conversion of inflammatory T cells in immunosuppressive regulatory T cells (Tregs). We analyzed the significance of the IDO:Treg axis for inducing and maintaining mucosal healing in ulcerative colitis (UC).Methods:Dextran sodium sulphate (DSS)-induced colitis in BALB/c mice (model for mucosal healing) and C57BL/6 mice (model for persistent disease) was used. Serum, fecal samples and colon-infiltrating immune cells of 65 patients with UC with mucosal healing or persistent colitis were analyzed.Results:Significantly higher serum levels of kynurenine and downregulated inflammatory cytokines were noticed in DSS-treated BALB/c mice compared with C57BL/6 mice. Increased IDO activity and attenuated capacity for antigen presentation and production of inflammatory cytokines, observed in BALB/c DCs, was followed by a significantly lower number of inflammatory T helper 1 (Th1) and Th17 cells and a notably increased number of Tregs in the colons of DSS-treated BALB/c mice. DCs and Tregs were crucially important for the maintenance of mucosal healing since their depletion aggravated colitis. Mucosal healing, followed by an increase in kynurenine and intestinal Tregs, was re-established when BALB/c DCs were transferred into DC-depleted or Treg-depleted DSS-treated BALB/c mice. This phenomenon was completely abrogated by the IDO inhibitor. Significantly higher serum and fecal levels of kynurenine, accompanied by an increased presence of intestinal Tregs, were noticed in patients with UC with mucosal healing and negatively correlated with disease severity, fecal calprotectin, colon-infiltrating interferon γ and interleukin-17-producing cells, serum and fecal levels of inflammatory cytokines.Conclusion:IDO-dependent expansion of endogenous Tregs should be further explored as a new approach for the induction and maintenance of mucosal healing in patients with UC.

show abstract

Assessment of Histological Remission in Ulcerative Colitis: Discrepancies Between Daily Practice and Expert Opinion

Cited by 30 publications

References 45 publications

Review article: faecal calprotectin and histologic remission in ulcerative colitis

Review article: faecal calprotectin and histologic remission in ulcerative colitis

Variability in the Distribution of Histological Disease Activity in the Colon of Patients with Ulcerative Colitis

Indoleamine 2,3-dioxygenase-dependent expansion of T-regulatory cells maintains mucosal healing in ulcerative colitis

Contact Info

Product

Resources

About