The association between
endoscopic and histological
inflammation in ulcerative colitis
Klaus Theede, MD
Gastrounit, Medical Division
Copenhagen University Hospital Hvidovre
Denmark
Disclosures
The study was supported by grants from
AbbVie Inc.
Ferring Pharmaceuticals
Mucosal healing
• Mucosal healing has emerged as a key treatment goal in
ulcerative colitis making endoscopy an important part of
disease monitoring
• Endoscopic evaluation of treatment response is now
widely recommended
• Histological acute inflammation despite endoscopic
mucosal healing is present in some patients and carries
an increased risk of relapse1+2
1Riley
et al, GUT, 1991
et al, Am J Gastroenterol, 2012
2Bessissow
Methods
• 76 patients comprising both active and inactive ulcerative colitis underwent
sigmoideoscopy and rectal biopsies.
Endoscopic evaluation of the inflammation:
• Mayo Endoscopic Score
•
•
Widely implemented in daily
practice and clinical trials
Patients divided into 4 categories
with increasing inflammatory
activity
• Ulcerative Colitis Endoscopic Index of Severity
•
•
•
Newly developed scoring system1
Composite system
3 different descriptors
• Vascular pattern
• Bleeding
• Presence of erosions/ulcers
1Travis
et al, GUT 2012
Methods
• Sections from the biopsies were evaluated by two independent “blind”
pathologists for the inflammatory activity using a four-point grading system
(0-3), which included extent of cryptitis and crypt abscesses as well as the
presence of erosions/ulcers.
•
The chronicity of the inflammation was not evaluated
0
(0 %)
Cryptitis
Crypt abscess
Erosions/ulcers
(absent vs. present)
1
(< 10 %)
2
(10 – 50 %)
3
(> 50 %)
Results
Age (years)
38 (19-76)
Gender
• Male
• Female
32 (42 %)
44 (58 %)
Disease duration (years)
5 years (0.0-48.5)
Endoscopic activity
• Active (Mayo = 1-3)
• Inactive (Mayo = 0)
45 (59.2 %)
31 (40.8 %)
Disease extent
• Proctitis
• Procto-sigmoiditis
• Left-sided or pancolitis
15 (33 %)
10 (22 %)
20 (44 %)
Results
UCEIS
Mayo Endoscopic Score
0
1
2
3
Total
3
28
0
0
0
28
4
4
2
0
0
6
5
1
7
0
0
8
6
0
2
4
0
6
7
0
2
11
0
13
8
0
0
5
0
5
9
0
0
2
5
7
10
0
0
0
3
3
Total
33
13
22
8
76
Gamma:
0.99, CI95% (0.98-1)
Results
Histology
Mayo Endoscopic Score
0
1
2
3
Total
0
25
3
0
1
29
1
6
3
6
0
15
2
0
3
6
1
10
3
0
4
9
6
19
Total
31
13
21
8
73
Gamma:
0.83, CI95% (0.70-0.95)
19 %
Histology
UCEIS
3
4
5
6
7
8
9
10
Total
0
23
2
2
1
0
0
1
0
29
1
4
3
1
2
3
2
0
0
15
2
0
0
1
2
4
2
1
0
10
3
0
0
4
1
6
1
4
3
19
Total
27
5
8
6
13
5
6
3
73
Gamma:
0.76, CI95% (0.63-0.89)
15 %
Conclusion
• Strong, significant association between Mayo Endoscopic Score and
Ulcerative Colitis Endoscopic Index of Severity (UCEIS)
• Significant association between histological inflammation and the
endoscopic grade of inflammation evaluated with both Mayo
Endoscopic Score and Ulcerative Colitis Endoscopic Index of Severity
Conclusion
• Histological inflammation in 15 -19 % of the patients with endosopic
mucosal healing
• residual inflammation from previous active disease?
• medical treatment?
• special phenotype?
• These patients seems to have a higher rate of relapse – we need to
obtain biopsies routinely to identify these patients when endoscopy
reveals mucosal healing
Acknowledgments and disclosures
• Co-workers
•
•
•
•
Susanne Holck, MD, DMSc1
Per Ibsen, MD1
Inge Nordgaard-Lassen, MD, DMSc2
Anette Mertz Nielsen, MD, DMSc2
1Department
of Pathology, Copenhagen University Hospital Hvidovre, Denmark
2Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Denmark