Histological healing as a predictor of sustained clinical remission in paediatric ulcerative colitis
Luca Scarallo1, Lorenzo Fioretti2, Monica Paci2
1Gastroenterology and Nutrition Unit, Meyer Children Hospital IRCCS, Florence, Italy; Department of NEUROFARBA, University of Florence, Italy.
Insights
Achieving endoscopic healing (EH) and histological healing (HH) in pediatric ulcerative colitis (UC) patients reduces disease relapses. Patients with complete HH experience longer relapse-free survival, indicating better long-term outcomes.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Outcomes in Ulcerative Colitis
Background:
- Ulcerative colitis (UC) management in children requires assessing healing beyond clinical symptoms.
- Endoscopic healing (EH) and histological healing (HH) are crucial indicators of treatment success in pediatric UC.
- Longitudinal data on the impact of EH and HH in pediatric UC cohorts are essential for refining treatment strategies.
Purpose of the Study:
- To evaluate the longitudinal association between endoscopic healing (EH) and histological healing (HH) and disease relapse in pediatric ulcerative colitis (UC) patients.
- To determine if achieving different levels of EH and HH impacts recurrence-free survival rates.
- To provide insights into the prognostic value of mucosal healing in managing pediatric UC.
Main Methods:
- Retrospective, single-center longitudinal study of 86 pediatric UC patients.
- Endoscopic re-assessment using Mayo Endoscopic Subscore (MES) to define partial (MES=1) and complete EH (MES=0).
- Histological assessment to define histological healing (HH) as absence of active inflammation; evaluation of cumulative incidence of clinical relapse.
Main Results:
- 68.6% of patients achieved EH (MES ≤1) at re-evaluation, with 66% of those achieving complete EH (MES=0).
- 20 out of 39 patients with complete EH also achieved complete HH.
- Patients achieving partial or complete EH demonstrated significantly higher recurrence-free survival (p < 0.01). Complete EH with HH showed lower recurrence than incomplete EH (p=0.049).
Conclusions:
- Endoscopic healing (EH) and histological healing (HH) are significantly associated with reduced disease relapses in pediatric ulcerative colitis (UC).
- Achieving complete histological healing (HH) in conjunction with endoscopic healing leads to longer relapse-free survival.
- These findings underscore the importance of deep remission, including mucosal healing, for improved long-term outcomes in pediatric UC.
Background:
The study aimed to assess the longitudinal impact of endoscopic healing (EH) and histological healing (HH) in a cohort of paediatric patients affected by ulcerative colitis (UC).
Methods:
This was a retrospective single-centre longitudinal study. 86 children with UC who underwent endoscopic re-assessment while in clinical and biochemical remission were included. Partial EH was defined as a Mayo Endoscopic Subscore (MES) of 1 and complete EH was defined as a MES of 0. HH was defined as the absence of active inflammation in all biopsies. The cumulative incidence of clinical relapse was evaluated during follow-up.
Results:
At the second endoscopic re-evaluation, 59 (68.6%) patients achieved EH (MES ≤1). Of these patients, 39 (66%) achieved complete EH. 20 of the 39 patients who achieved complete EH attained complete HH. Patients who achieved partial and complete EH showed higher recurrence-free survival rates compared to those who did not (p < 0.01 and p < 0.01, respectively). Amongst patients with complete EH, those who achieved complete HH had lower recurrence rates when compared to patients who still showed microscopic inflammation (p = 0.049).
Conclusion:
Achievement of EH and HH is associated with fewer disease relapses, with patients achieving HH showing longer relapse-free survival rates.
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