Association of endoscopic and histological remission with clinical course in patients of ulcerative colitis

Abstract

Background/AimsThe therapeutic goal for treating ulcerative colitis (UC) patients has shifted to achieving mucosal healing over the past few years. However, at present, limited data is available on the correlation between endoscopic findings and histological remission in patients with endoscopic mucosal healing.MethodsThis was a prospective observational study conducted over a period of 18 months (January 2014 to June 2015) at Dayanand Medical College and Hospital, Ludhiana, Punjab, India. Patients diagnosed with UC who had been in clinical remission (n=76) for at least 6 months were evaluated for endoscopic remission. Those in endoscopic remission (Mayo score ≤1; 46/76, 60.5%) were subjected to multiple biopsies from the rectosigmoid region and histological remission, which was then defined as grade 0/1 as per the Geboes criteria.ResultsOf the 46 patients in endoscopic remission (age, 18–73 years; male:female=1.5:1.0), majority had E1 (proctitis) disease (21/46, 45.6%) followed by E2 (left sided colitis) (18/46, 39.1%) and E3 disease (pancolitis) (7/46, 15.2%) at baseline. Histological remission was noted in 67.3% (31/46) of the patients, while 32.7% (15/46) still retained the histologically active disease in the form of infiltration of the lamina propria by eosinophils and neutrophils (13/15, 86.6%), cryptitis (14/15, 93.3%), and crypt abscesses (8/15, 53.3%). On follow-up, after 1 year, 87.1% (27/31) of the patients who had been in histological remission remained clinically asymptomatic, while 12.9% (4/31) had relapsed. Among the 15 histologically active patients, 46.6% (7/15) remained in clinical remission, while 53.3% (8/15) had relapsed.ConclusionsHistological remission, rather than endoscopic remission, predicts a sustained clinical remission and allows monitoring of therapy for the subsequent disease course in patients with UC.

Prostaglandin E-major urinary metabolite versus fecal immunochemical occult blood test as a biomarker for patient with ulcerative colitis

“…To clarify that point, there is a need for periodic measurements of PGE-MUM to be performed in the same patient and prospective follow-up be performed of patients with relapse. In recent years, treatments aimed at histological healing more advanced than mucosal healing have also been required, and reports of the comparison between histological healing and biomarkers have been found [22][23][24][25]. Further studies are needed to determine if PGE-MUM could be a biomarker to predict histologic healing.…”

Temporal clinical, proteomic, histological and cellular immune responses of dextran sulfate sodium-induced acute colitis

“…These differences between studies may reflect the influence of the microbiome and/or the animals’ age, as previously reported in experimental DSS colitis[ 27 , 28 ]. In addition, it has been reported that UC patients in clinical and endoscopic based remission presenting with active histological inflammation possess a higher risk for clinical relapse[ 29 , 30 ]. In this way, our study may provide an understanding of the pathological and clinical response of severe human UC, with higher chances of relapsing and chronic disease.…”

The emerging role of histologic disease activity assessment in ulcerative colitis

“…Limited studies have evaluated the role of eosinophils in UC. Narang et al 32 followed 76 Indian patients with UC in clinical remission. Of these patients, 60.5% (46/76) were in endoscopic remission (MES 1) and 32.7% (15/46) had histologic evidence of activity.…”