Histologic Markers of Inflammation in Patients With Ulcerative Colitis in Clinical Remission

Abstract

Background & Aims Mucosal healing, based on histologic analysis, is an endpoint of maintenance therapy for patients with ulcerative colitis (UC). There are few data on how histologic signs of inflammation correlate with endoscopic and peripheral blood measures of inflammation in these patients. We investigated patterns of histologic features of inflammation in patients with UC in clinical remission, and correlated these with endoscopic and biochemical measures of inflammation. Methods We performed a prospective observational study of 103 patients with UC in clinical remission undergoing surveillance colonoscopy while receiving maintenance therapy with mesalamine or thiopurines; 2674 biopsies were collected from 708 colonic segments. Each colonic segment was evaluated based on the Mayo endoscopic sub-score and the Geboes histology score (0–5.4). Biomarkers were measured in peripheral blood samples. Results Histologic features of inflammation were found in 54% of patients receiving maintenance therapy; 37% had at least moderate inflammation, based on histology scores. Of the 52 patients with endoscopic evidence only of left-sided colitis, 34% had histologic features of inflammation in their proximal colon. Histology scores correlated with endoscopic scores for per-segment inflammation (Spearman’s ρ=0.65; P<.001). Patients with histology scores >3.1 had a significantly higher mean level of C-reactive protein (CRP) than those with scores <3.1. There were no differences among treatment groups in percentages of patients with histologic scores >3.1. Conclusions Patients in clinical remission from UC still frequently have histologic features of inflammation, which correlate with endoscopic appearance. Patients with at least moderate levels of inflammation, based on histologic grading (score >3.1), have higher serum levels of CRP, which could be used as a surrogate marker of histologic inflammation.

Low Mass Blood Peptides Discriminative of Inflammatory Bowel Disease (IBD) Severity: A Quantitative Proteomic Perspective

“…Here we have shown that levels of ␣-1-microglobulin are increased in remission compared with control for UC patients and higher in these patients than in UC active disease. Sufferers in clinical remission are known to display the histological features of inflammation which correlate with endoscopic appearance (59). This AMBP cleavage product detectable in blood is able to highlight clinical remission and could therefore provide an alternative measure over colonoscopic evaluations.…”

Associations among body composition, inflammatory profile and disease extent in ulcerative colitis patients

“…Even though CRP short half-life of 19 h could not support such explanation, a recent study showed that a mean CRP levels of 5.4 mg/L (normal range) was associated with high histological inflammation scores in patients with ulcerative colitis during clinical remission. 45 Such results raise awareness to the fact that patients in clinical remission from UC still may have inflammation.…”

“…It represents the most metabolically active compartment of the body and catabolic conditions may lead to its reduction. 17 It is plausible that more extensive UC is associated with less protein deposits, as seen in other diseases, 45 and/ or related with high catabolic conditions. 17 Considering the results found in our population we might suggest that patients with better lean body mass had a lower susceptibility to the development of more extensive injury.…”

Assessment of Mucosal Healing in Inflammatory Bowel Disease

“…Histological inflammation is common even when the mucosa appears normal [18]. Accumulated evidence indicates that persistent histological disease is associated with an increased risk of hospitalization, colectomy, relapse, and colorectal neoplasia [19][20][21].…”