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CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(04): E568-E575
DOI: 10.1055/a-0869-7619
Original article
Owner and Copyright © Georg Thieme Verlag KG 2019

Relationship between endoscopic mucosal healing and histologic inflammation during remission maintenance phase in ulcerative colitis: a retrospective study

Mimari Kanazawa
1   Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
,
Fumiaki Takahashi
1   Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
2   Department of Internal Medicine, Japanese Red Cross Ashikaga Hospital, Tochigi, Japan
,
Keiichi Tominaga
1   Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
,
Keiichiro Abe
1   Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
,
Naoya Izawa
1   Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
,
Koh Fukushi
1   Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
,
Kazunori Nagashima
1   Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
,
Akira Kanamori
1   Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
,
Kazuhiro Takenaka
1   Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
,
Takeshi Sugaya
1   Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
,
Makoto Iijima
1   Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
,
Atsuko Takada
3   Department of Diagnostic Pathology, Dokkyo Medical University, Tochigi, Japan
,
Yasuo Imai
3   Department of Diagnostic Pathology, Dokkyo Medical University, Tochigi, Japan
,
Hideyuki Hiraishi
1   Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
,
Atsushi Irisawa
1   Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
› Author Affiliations
Further Information

Publication History

submitted 30 August 2018

accepted after revision 07 February 2019

Publication Date:
04 April 2019 (online)

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Abstract

Background and study aims Recently, histological inflammation has been suggested to be an important predictor of sustained remission or relapse of ulcerative colitis (UC). In this study, we retrospectively compared severity of histological inflammation with endoscopic findings in UC patients with mucosal healing (MH) in the remission maintenance phase, and investigated whether histological healing could be a predictor of sustained remission.

Patients and methods This study included 166 patients with MH in the remission maintenance phase. Endoscopic evaluation was based on the Mayo endoscopic subscore (MES), and MH was defined as MES 0 or 1. Severity of histological inflammation was graded according to the Matts classification. Patients with Matts 1 and 2 were included in the histological healing (HH) group, and those with Matts 3, 4, and 5, in the non-histological healing (NHH) group. In patients with MH, incidence of relapse was compared and analyzed according to severity of histological inflammation.

Results The remission maintenance rate was significantly higher in the MES 0 group than in the MES 1 group (P = 0.004). The rate was significantly higher in the HH group than in the NHH group (P = 0.003). Within the MES 1 group, the rate was significantly higher in the HH subgroup than in the NHH subgroup (P = 0.030).

Conclusions This retrospective study suggests that histological healing can be a predictor of sustained remission in UC patients, and examination of histological inflammation provides useful information for long-term management of UC, particularly in patients with MES 1.

 

  • References

  • 1 Kornbluth A, Sachar DB. Practice Parameters Committee of the American College of Gastroenterology. Ulcerative colitis practice guidelines in adults: American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol 2010; 105: 501-523
    CrossrefPubMedGoogle Scholar
  • 2 D'Haens G, Sandborn WJ, Feagan BG. et al. A review of activity indices and efficacy end points for clinical trials of medical therapy in adults with ulcerative colitis. Gastroenterology 2007; 132: 763-786
    CrossrefPubMedGoogle Scholar
  • 3 Froslie KF, Jahnsen J, Moum BA. et al. Mucosal healing in inflammatory bowel disease: results from a Norwegian population-based cohort. Gastroenterology 2007; 133: 412-422
    CrossrefPubMedGoogle Scholar
  • 4 Truelove SC, Richards WC. Biopsy studies in ulcerative colitis. Br Med J 1956; 1: 1315-1318
    CrossrefPubMedGoogle Scholar
  • 5 Neurath MF, Travis SP. Mucosal healing in inflammatory bowel diseases: a systematic review. Gut 2012; 61: 1619-1635
    CrossrefPubMedGoogle Scholar
  • 6 Colombel JF, Rutgeers P, Reinisch W. et al. Early mucosal healing with infliximab is associated with improved longterm clinical outcomes in ulcerative colitis. Gastroenterology 2011; 141: 1194-1201
    CrossrefPubMedGoogle Scholar
  • 7 Meucci G, Fasoli R, Saibeni S. et al. Prognostic significance of endoscopic remission in patients with active ulcerative colitis treated with oral and topical mesalazine: a prospective, multicenter study. Inflamm Bowel Dis 2012; 18: 1006-1010
    CrossrefPubMedGoogle Scholar
  • 8 Ardizzone S, Andrea C, Piergiorgio D. et al. Mucosal healing predicts late outcomes after the first course of corticosteroids for newly diagnosed ulcerative colitis. Clin Gastroenterol Hepatol 2011; 9: 483-489
    CrossrefPubMedGoogle Scholar
  • 9 Gibson PR, Vaizey C, Black CM. et al. Relationship between disease severity and quality of life and assessment of health care utilization and cost for ulcerative colitis in Australia: a cross-sectional, observational study. J Crohns Colitis 2014; 8: 598-606
    CrossrefPubMedGoogle Scholar
  • 10 Takahashi F, Tominaga K, Kanamori A. et al. Timing for dose-down of 5-ASA depends on mucosal status with ulcerative colitis. Scand J Gastroenterol 2016; 51: 827-834
    CrossrefPubMedGoogle Scholar
  • 11 Sandborn WJ, Rutgeerts P, Feagan BG. et al. Colectomy rate comparison after treatment of ulcerative colitis with placebo or infliximab. Gastroenterology 2009; 137: 1250-1260
    CrossrefPubMedGoogle Scholar
  • 12 Feagan BG, Reinisch W, Rutgeerts P. et al. The effects of infliximab therapy on health-related quality of life in ulcerative colitis patients. Am J Gastroenterol 2007; 102: 794-802
    CrossrefPubMedGoogle Scholar
  • 13 Peyrin-Biroulet L, Sandborn W, Sands BE. et al. Selecting therapeutic targets in inflammatory bowel disease (STRIDE): determining therapeutic goals for treat-to-target. Am J Gastroenterol 2015; 110: 1324-1338
    CrossrefPubMedGoogle Scholar
  • 14 Boal Carvalho P, Cotter J. Mucosal healing in ulcerative colitis: a comprehensive review. Drugs 2017; 77: 159-173
    CrossrefPubMedGoogle Scholar
  • 15 Riley SA, Mani V, Goodman MJ. et al. Microscopic activity in ulcerative colitis: what does it mean?. Gut 1991; 32: 174-178
    CrossrefPubMedGoogle Scholar
  • 16 Bessissow T, Lemmens B, Ferrante M. et al. Prognostic value of serologic and histologic markers on clinical relapse in ulcerative colitis patients with mucosal healing. Am J Gastroenterol 2012; 107: 1684-1692
    CrossrefPubMedGoogle Scholar
  • 17 Bitton A, Peppercorn MA, Antonioli DA. et al. Clinical, biological, and histologic parameters as predictors of relapse in ulcerative colitis. Gastroenterology 2001; 120: 13-20
    CrossrefPubMedGoogle Scholar
  • 18 Park S, Abdi T, Gentry M. et al. Histological disease activity as a predictor of clinical relapse among patients with ulcerative colitis: systematic review and meta-analysis. Am J Gastroenterol 2016; 111: 1692-1701
    CrossrefPubMedGoogle Scholar
  • 19 Bryant RV, Burger DC, Delo J. et al. Beyond endoscopic mucosal healing in UC: histological remission better predicts corticosteroid use and hospitalisation over 6 years of follow-up. Gut 2016; 65: 408-414
    CrossrefPubMedGoogle Scholar
  • 20 Feagins LA, Melton SD, Iqbal R. et al. Clinical implications of histologic abnormalities in colonic biopsy specimens from patients with ulcerative colitis in clinical remission. Inflamm Bowel Dis 2013; 19: 1477-1482
    CrossrefPubMedGoogle Scholar
  • 21 Rachmilewitz D. Coated mesalazine (5-aminosalicylic acid) versus sulphasalazine in the treatment of active ulcerative colitis: a randomised trial. BMJ 1989; 298: 82-86
    CrossrefPubMedGoogle Scholar
  • 22 Matsuoka K, Kobayashi T, Ueno F. et al. Evidence-based clinical practice guidelines for inflammatory bowel disease. J Gastroenterol 2018; 53: 305-353
    CrossrefPubMedGoogle Scholar
  • 23 Silverberg MS, Satsangi J, Ahmad T. et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol 2005; 19: 5A-36A
    CrossrefPubMedGoogle Scholar
  • 24 Satsangi J, Silverberg MS, Vermeire S. et al. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut 2006; 55: 749-753
    CrossrefPubMedGoogle Scholar
  • 25 Schroeder KW, Tremaine WJ, Ilstrup DM. Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study. N Engl J Med 1987; 317: 1625-1629
    CrossrefPubMedGoogle Scholar
  • 26 Scherl EJ, Pruitt R, Gordon GL. et al. Safety and efficacy of a new 3.3 g b.i.d. tablet formulation in patients with mild-to-moderately-active ulcerative colitis: a multicenter, randomized, double-blind, placebo-controlled study. Am J Gastroenterol 2009; 104: 1452-1459
    CrossrefPubMedGoogle Scholar
  • 27 Matts SG. The value of rectal biopsy in the diagnosis of ulcerative colitis. Q J Med 1961; 30: 393-407
    PubMedGoogle Scholar
  • 28 Nakarai A, Kato J, Hiraoka S. et al. Prognosis of ulcerative colitis differs between patients with complete and partial mucosal healing, which can be predicted from the platelet count. World J Gastroenterol 2014; 20: 18367-18374
    CrossrefPubMedGoogle Scholar
  • 29 Rubin DT, Huo D, Kinnucan JA. et al. Inflammation is an independent risk factor for colonic neoplasia in patients with ulcerative colitis: a case-control study. Clin Gastroenterol Hepatol 2013; 11: 1601-1608
    CrossrefPubMedGoogle Scholar
  • 30 Gupta RB, Harpaz N, Itzkowitz S. et al. Histologic inflammation is a risk factor for progression to colorectal neoplasia in ulcerative colitis: a cohort study. Gastroenterology 2007; 133: 1099-1105
    CrossrefPubMedGoogle Scholar
  • 31 Hefti MM, Chessin DB, Harpaz NH. et al. Severity of inflammation as a predictor of colectomy in patients with chronic ulcerative colitis. Dis Colon Rectum 2009; 52: 193-197
    CrossrefPubMedGoogle Scholar
  • 32 Peyrin-Biroulet L, Bressenot A, Kampman W. Histologic remission: the ultimate therapeutic goal in ulcerative colitis?. Clin Gastroenterol Hepatol 2014; 12: 929-934
    CrossrefPubMedGoogle Scholar
  • 33 Christensen B, Hanauer SB, Erlich J. et al. Histologic normalization occurs in ulcerative colitis and is associated with improved clinical outcomes. Clin Gastroenterol Hepatol 2017; 15: 1557-1564
    CrossrefPubMedGoogle Scholar