Histologic healing and clinical outcomes in ulcerative colitis
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 r...
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Korean Association for the Study of Intestinal Diseases
2025-04-01
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| Series: | Intestinal Research |
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| Online Access: | http://irjournal.org/upload/pdf/ir-2024-00058.pdf |
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| author | Raymond Fueng-Hin Liang Huiyu Lin Cora Yuk-Ping Chau Wee Chian Lim |
| author_facet | Raymond Fueng-Hin Liang Huiyu Lin Cora Yuk-Ping Chau Wee Chian Lim |
| author_sort | Raymond Fueng-Hin Liang |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-6adaa6cf93e14d36bcd52f7e9cacd8fa |
| institution | Kabale University |
| issn | 1598-9100 2288-1956 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Korean Association for the Study of Intestinal Diseases |
| record_format | Article |
| series | Intestinal Research |
| spelling | doaj-art-6adaa6cf93e14d36bcd52f7e9cacd8fa2025-08-20T03:53:47ZengKorean Association for the Study of Intestinal DiseasesIntestinal Research1598-91002288-19562025-04-0123218219210.5217/ir.2024.000581084Histologic healing and clinical outcomes in ulcerative colitisRaymond Fueng-Hin Liang0Huiyu Lin1Cora Yuk-Ping Chau2Wee Chian Lim3 Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore Department of Pathology, Tan Tock Seng Hospital, Singapore Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, SingaporeBackground/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.http://irjournal.org/upload/pdf/ir-2024-00058.pdfulcerative colitisintestinal mucosahistology |
| spellingShingle | Raymond Fueng-Hin Liang Huiyu Lin Cora Yuk-Ping Chau Wee Chian Lim Histologic healing and clinical outcomes in ulcerative colitis Intestinal Research ulcerative colitis intestinal mucosa histology |
| title | Histologic healing and clinical outcomes in ulcerative colitis |
| title_full | Histologic healing and clinical outcomes in ulcerative colitis |
| title_fullStr | Histologic healing and clinical outcomes in ulcerative colitis |
| title_full_unstemmed | Histologic healing and clinical outcomes in ulcerative colitis |
| title_short | Histologic healing and clinical outcomes in ulcerative colitis |
| title_sort | histologic healing and clinical outcomes in ulcerative colitis |
| topic | ulcerative colitis intestinal mucosa histology |
| url | http://irjournal.org/upload/pdf/ir-2024-00058.pdf |
| work_keys_str_mv | AT raymondfuenghinliang histologichealingandclinicaloutcomesinulcerativecolitis AT huiyulin histologichealingandclinicaloutcomesinulcerativecolitis AT corayukpingchau histologichealingandclinicaloutcomesinulcerativecolitis AT weechianlim histologichealingandclinicaloutcomesinulcerativecolitis |