Histologic healing and clinical outcomes in ulcerative colitis.

IF 3.4 Q2 GASTROENTEROLOGY & HEPATOLOGY Intestinal Research Pub Date : 2024-09-19 DOI:10.5217/ir.2024.00058

Raymond Fueng-Hin Liang, Huiyu Lin, Cora Yuk-Ping Chau, Wee Chian Lim

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Abstract

Background/aims: Growing evidence suggests histologic healing (HH) improves clinical outcomes in ulcerative colitis (UC) patients beyond endoscopic healing (EH). We hypothesize that HH is associated with better clinical outcomes in Asian UC patients, for whom data is lacking.

Methods: We performed a retrospective study of UC patients in clinical remission (CR) with a follow-up colonoscopy and minimum 1-year follow-up post-colonoscopy. Primary outcome was clinical relapse (CRL), defined as either a Simple Clinical Colitis Activity Index score of > 2, medication escalation, hospitalization or colectomy. Predictors of CRL and HH were assessed.

Results: One hundred patients were included with a median follow-up of 22 months. At index colonoscopy, 80 patients were in EH. On follow-up, 41 patients experienced CRL. Of 80 patients in EH, 34 (42.5%) had persistent histologic activity (Nancy Index ≥ 2) and 29 (36.3%) relapsed during the follow-up period. Amongst patients in CR and EH, those with HH had lower CRL rate (26.1% vs. 50.0%, P= 0.028) and longer CRL-free survival (mean 46.1 months vs. 31.5 months, P= 0.015) than those with persistent histologic activity. On bivariable analysis of 100 patients in CR, HH, and Mayo endoscopic score (MES) of 0 were significantly associated with lower risk of CRL. On multivariable analysis, only MES 0 remained predictive of lower CRL risk.

Conclusions: Above and beyond CR and EH, achieving HH improves clinical outcomes in Asian UC patients. However, HH may not confer incremental benefit if MES 0 has been achieved. Further prospective studies evaluating the benefit of histologically guided therapeutic decisions are needed.

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溃疡性结肠炎的组织学愈合和临床疗效。

背景/目的：越来越多的证据表明，组织学愈合（HH）比内镜愈合（EH）更能改善溃疡性结肠炎（UC）患者的临床预后。我们假设组织学愈合与亚洲 UC 患者更好的临床疗效有关，因为目前尚缺乏这方面的数据：我们对临床缓解（CR）的 UC 患者进行了一项回顾性研究，患者接受了结肠镜检查，并在结肠镜检查后进行了至少 1 年的随访。主要结果是临床复发（CRL），定义为简单临床结肠炎活动指数评分>2、药物治疗升级、住院或结肠切除术。对 CRL 和 HH 的预测因素进行了评估：共纳入 100 名患者，中位随访时间为 22 个月。在接受结肠镜检查时，80 名患者处于 EH 状态。随访期间，41 名患者出现 CRL。在80例EH患者中，34例（42.5%）在随访期间有持续的组织学活动（南希指数≥2），29例（36.3%）复发。在CR和EH患者中，与组织学活动持续存在的患者相比，HH患者的CRL率较低（26.1% vs. 50.0%，P= 0.028），无CRL生存期较长（平均46.1个月 vs. 31.5个月，P= 0.015）。在对100名CR患者进行的双变量分析中，HH和梅奥内镜评分（MES）为0与较低的CRL风险显著相关。在多变量分析中，只有 MES 0 仍可预测较低的 CRL 风险：结论：除 CR 和 EH 外，达到 HH 可改善亚洲 UC 患者的临床预后。结论：除了 CR 和 EH 外，HH 还能改善亚洲 UC 患者的临床预后。然而，如果 MES 已达到 0，HH 可能不会带来更多益处。需要进一步开展前瞻性研究，评估在组织学指导下做出治疗决定的益处。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Intestinal Research GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

7.40

自引率

10.20%

发文量

审稿时长

38 weeks

期刊介绍： Intestinal Research (Intest Res) is the joint official publication of the Asian Organization for Crohn''s and Colitis (AOCC), Chinese Society of IBD (CSIBD), Japanese Society for IBD (JSIBD), Korean Association for the Study of Intestinal Diseases (KASID), Taiwan Society of IBD (TSIBD) and Colitis Crohn''s Foundation (India) (CCF, india). The aim of the Journal is to provide broad and in-depth analysis of intestinal diseases, especially inflammatory bowel disease, which shows increasing tendency and significance. As a Journal specialized in clinical and translational research in gastroenterology, it encompasses multiple aspects of diseases originated from the small and large intestines. The Journal also seeks to propagate and exchange useful innovations, both in ideas and in practice, within the research community. As a mode of scholarly communication, it encourages scientific investigation through the rigorous peer-review system and constitutes a qualified and continual platform for sharing studies of researchers and practitioners. Specifically, the Journal presents up-to-date coverage of medical researches on the physiology, epidemiology, pathophysiology, clinical presentations, and therapeutic interventions of the intestinal diseases. General topics of interest include inflammatory bowel disease, colon and small intestine cancer or polyp, endoscopy, irritable bowel syndrome and other motility disorders, infectious enterocolitis, intestinal tuberculosis, and so forth. The Journal publishes diverse types of academic materials such as editorials, clinical and basic reviews, original articles, case reports, letters to the editor, brief communications, perspective, statement or commentary, and images that are useful to clinicians and researchers.