Histopathology Predictors of Medically Refractory Ulcerative Colitis

Melson, Joshua; Giusto, Deborah; Kwasny, Mary; Eichenseer, Peter; Jakate, Shriram; Keshavarzian, Ali

doi:10.1007/dcr.0b013e3181e751df

Cited by 17 publications

(12 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1,3 We hypothesized that in adults and children UC course depends upon initial disease phenotype, therapy offered, and intrinsic patient biology. Initial disease severity, lack of response to early therapy, hypoalbuminemia, anemia, low serum 25 (OH) D, colonic histology, and specific genetic polymorphisms have been associated with worse clinical outcomes 2,[4][5][6] , though data largely come from studies lacking standardised treatment and many have focused on acutely ill hospitalized patients. In a paediatric observational registry with no standardisation of initial therapy, less than 40% of children newly diagnosed with UC were in CS-free remission without the need for immunomodulators or anti-TNFα therapy one year after diagnosis 7 .…”

Section: Introductionmentioning

confidence: 99%

Clinical and biological predictors of response to standardised paediatric colitis therapy (PROTECT): a multicentre inception cohort study

et al. 2019

View full text Add to dashboard Cite

Background-The lack of evidence-based outcomes data leads to uncertainty in developing treatment regimens in children newly diagnosed with Ulcerative Colitis (UC). We hypothesized that pre-treatment clinical, transcriptomic, and microbial factors predict disease course. Methods-We performed an inception cohort study of 428 paediatric UC patients receiving standardised mesalazine or corticosteroids (CS), with pre-established criteria for escalation to thiopurines or anti-TNFα. RNA sequencing (n=206) defined pre-treatment rectal gene expression. 16S sequencing (n=343) characterized rectal/fecal microbiota. The primary outcome was Week 52 CS-free remission (SFR) with no therapy beyond mesalazine. Findings-Week 52 SFR was achieved in 150/400 (38%) participants; 74/400 (19%) received thiopurines alone, 12¾00 (31%) received anti-TNFα, and 25/400 (6%) colectomy. Lower baseline clinical severity, higher baseline hemoglobin, and Week 4 clinical remission were associated with achieving Week 52 SFR (logistic model AUC:0.70 (95% CI 0.65-0.75), specificity 77% (CI 71-82), n=386). Baseline severity and week 4 remission were validated inan independent cohort of 274 participants. An antimicrobial peptide gene signature (OR:0.6, p=0.002) and Ruminococcaceae (OR:1.4, p=0.04) and Sutterella (OR: 0.8, p=0.05) abundance were independently associated with SFR after adjusting for the clinical predictors. Amongst moderateto-severe patients, escalation to anti-TNFα was associated with increased baseline clinical severity and decreased hemoglobin, serum 25 (OH) D, and rectal eosinophils (logistic model AUC:0.78 (95% CI 0.72-0.84), specificity 85% (CI 78-93), n=232). A rectal transportgene signature (OR: 0.3, p=0.0006) and Oscillospira abundance (OR:0.6, p=0.02) were independently associated with escalation to anti-TNFα after adjusting for the clinical predictors. Interpretation-Our findings support the utility of using initial clinical activity and treatment response by 4 weeks to predict Week 52 CS-free remission with mesalazine alone in children newly diagnosed with UC. The development of personalized clinical and biological signatures holds the promise of informing UC therapeutic decisions.

show abstract

Section: Introductionmentioning

confidence: 99%

Clinical and biological predictors of response to standardised paediatric colitis therapy (PROTECT): a multicentre inception cohort study

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Previous studies have evaluated histological findings as predictors of medically refractory disease. Melson et al [33] showed that medically refractory UC is not predicted by the severity or extent of endoscopic findings but is associated with histological findings such as severe cryptitis and lymphoid follicles. The presence of rectal sparing may indicate more aggressive disease and is less responsive to medical treatment among pediatric patients with UC [34].…”

Section: Discussionmentioning

confidence: 99%

Colonic Histological Criteria Predict Development of Pouchitis after Ileal Pouch: Anal Anastomosis for Patients with Ulcerative Colitis

Araki

Hashimoto²,

Okita³

et al. 2017

Dig Surg

View full text Add to dashboard Cite

Background/Aims: Pouchitis is one of the main complications after ileal pouch-anal anastomosis in patients with ulcerative colitis. The aim of this study was to determine whether the use of colonic histological criteria can predict the development of pouchitis. Methodology: We retrospectively reviewed 147 patients' clinical data and performed a histological evaluation of the resected total colon using Tanaka's criteria, which comprise the following 6 factors: ulceration (H₁), crypt abscesses (H₂), degree of mononuclear cell infiltration (MNCI) (H₃), segmental distribution of MNCI (H₄), eosinophil infiltration (H₅), and extent of disease of resected colon (H₆). Results: The development of pouchitis and chronic pouchitis within 3 years after restoration of gastrointestinal continuity was recognized in 52 (35.4%) and 26 (17.7%) of the 147 patients, respectively. Using various combinations of each score, the H₃ + H₄ - H₅ scores of patients with pouchitis or chronic pouchitis were significantly higher than those of patients without. A H₃ + H₄ - H₅ score of >0.4 was a statistically significant risk factor for the development of both pouchitis and chronic pouchitis. Conclusions: The combination of the degree of MNCI, segmental distribution of MNCI, and eosinophil infiltration from histological criteria has utility in predicting the future development of pouchitis, especially chronic pouchitis.

show abstract

“…They are, both, identified in active phase of UC [2]. They are predictive for an aggressive, refractory disease especially in older patients [19]. One study identified cryptitis in the majority of relapsing patients, while none of the non-relapsers had this feature on the initial biopsy [18].…”

Section: Cryptitis and Crypt Abscessesmentioning

confidence: 99%

Histologic Features with Predictive Value for Outcome of Patients with Ulcerative Colitis

Popp¹,

Mateescu²

2018

New Concepts in Inflammatory Bowel Disease

View full text Add to dashboard Cite

Ulcerative colitis is an inflammatory bowel disease with variable evolution, in which is difficult to establish patient's outcome. Histology is an important part of diagnosis of ulcerative colitis and has an increasing role in patients' management, since increasingly more histologic features with predictive value are being identified and validated. This chapter presents the most important histologic prognostic factors that should be included in histologic reports of patients with ulcerative colitis. Basal plasmacytosis and histologic healing are the most significant validated factors of prognosis in ulcerative colitis, while dysplasia is important since colorectal carcinoma is a severe complication of the disease.

show abstract

Histopathology Predictors of Medically Refractory Ulcerative Colitis

Cited by 17 publications

References 30 publications

Clinical and biological predictors of response to standardised paediatric colitis therapy (PROTECT): a multicentre inception cohort study

Clinical and biological predictors of response to standardised paediatric colitis therapy (PROTECT): a multicentre inception cohort study

Colonic Histological Criteria Predict Development of Pouchitis after Ileal Pouch: Anal Anastomosis for Patients with Ulcerative Colitis

Histologic Features with Predictive Value for Outcome of Patients with Ulcerative Colitis

Contact Info

Product

Resources

About