Histologic features and predicting prognosis in ulcerative colitis patients with mild endoscopic activity

Area of Science:

• Gastroenterology
• Inflammatory Bowel Disease Research
• Clinical Pathology

Background:

• Ulcerative colitis (UC) management relies on achieving mucosal healing (MH).
• Predicting prognosis in UC patients with partial or complete MH remains challenging.
• Histologic assessment is crucial for understanding disease activity beyond endoscopic appearance.

Purpose of the Study:

• To evaluate histologic features predicting prognosis in UC patients with complete or partial MH.
• To correlate predictive histologic findings with endoscopic observations.
• To identify risk factors for disease progression in UC.

Main Methods:

• Prospective data collection from UC patients undergoing endoscopic procedures with biopsies.
• Definition of complete MH (Mayo endoscopic subscore [MES] = 0) and partial MH (MES = 1).
• Evaluation of histologic variables, including the Nancy index (NI), for prediction of disease progression (medication upgrade, hospitalization, or surgery).

Main Results:

• Disease progression was observed exclusively in patients with partial MH (MES = 1).
• A Nancy index (NI) of 3 or higher significantly correlated with disease progression.
• Mucosal friability on endoscopy was significantly associated with NI ≥ 3 (88.0% vs. 61.1%, p=0.013).

Conclusions:

• Histologic activity, particularly assessed by NI, aids in predicting prognosis for UC patients with mild endoscopic activity.
• Endoscopic observation of mucosal friability may indicate more severe underlying histology.
• Mucosal friability can serve as a potential risk factor for UC disease progression.