In ulcerative colitis (UC), is histological remission a better predictor of a positive outcome than endoscopic remission?
In patients with UC, histological remission appears to be a better predictor of a long term positive outcome compared to endoscopic remission.
While evidence is mounting for us to use histological remission in our monitoring of response to therapy, as of today, endoscopic remission and mucosal healing still remain standard of care.
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 Mar;65(3):408–14. https://www.ncbi.nlm.nih.gov/pubmed/25986946
Patients with UC in 2007–2008 underwent baseline data collection (Simple Clinical Colitis Activity Index (SCCAI)), videosigmoidoscopy with mucosal assessment (Baron scoring system), and histology (Truelove and Richards’ index). Outcomes were assessed approximately 6 years later in 2014 and included oral corticosteroids, escalation to immunomodulators or biologics, hospitalization, or colectomy.
A total of 91 patients were followed (median: 72 months, IQR:54–75 months). Remission was achieved in 41%, 62%, and 52% as per clinical, endoscopic, and histological assessments, respectively. However, only 29% achieved remission with all three assessments (clinical + endoscopy + histology). Importantly, 24% had persistent inflammation despite endoscopic remission.
Histological remission outperformed endoscopic remission in predicting best outcomes. Specifically, patients with histological remission were less likely to require a second course of corticosteroids or escalate therapy (HR=0.42, P=0.02) or hospitalization (HR=0.21, P=0.02) during the 6 year follow-up period, whereas endoscopic remission alone did not achieve these best outcomes (P=0.74).
Study Design: Prospective observational longitudinal study
Setting: United Kingdom
Level of Evidence: 1b (Oxford Levels of Evidence)
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