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The association between endoscopic and histological inflammation in ulcerative colitis

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.

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The association between endoscopic and histological inflammation in ulcerative colitis

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  1. The association between endoscopic and histological inflammation in ulcerative colitis Klaus Theede, MD Gastrounit, Medical Division Copenhagen University Hospital Hvidovre Denmark

  2. Disclosures The study was supported by grants from AbbVie Inc. Ferring Pharmaceuticals

  3. 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 2Bessissow et al, Am J Gastroenterol, 2012

  4. Methods • 76 patients comprisingbothactive and inactiveulcerative colitis underwentsigmoideoscopy and rectalbiopsies. Endoscopic evaluation of the inflammation: • Ulcerative Colitis Endoscopic Index of Severity • Newlydeveloped scoring system1 • Composite system • 3 differentdescriptors • Vascular pattern • Bleeding • Presence of erosions/ulcers • Mayo Endoscopic Score • Widely implemented in daily practice and clinical trials • Patients divided into 4 categories with increasing inflammatory activity 1Travis et al, GUT 2012

  5. 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

  6. Results

  7. Results Gamma: 0.99, CI95% (0.98-1)

  8. Results Gamma: 0.83, CI95% (0.70-0.95) 19 % Gamma: 0.76, CI95% (0.63-0.89) 15 %

  9. Conclusion • Strong, significant association between Mayo Endoscopic Score and Ulcerative Colitis Endoscopic Index of Severity (UCEIS) • Significant association betweenhistologicalinflammation and the endoscopic grade of inflammation evaluated with both Mayo Endoscopic Score and Ulcerative Colitis Endoscopic Index of Severity

  10. Conclusion • Histological inflammation in 15 -19 % of the patients with endosopic mucosal healing • residual inflammation from previousactivedisease? • medicaltreatment? • specialphenotype? • 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

  11. 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

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