Histologic Disease Persists beyond Mucosal Healing and Could Predict Reactivation in Ulcerative Colitis
Lucrezia Laterza1, Anna Chiara Piscaglia2, Stefano Bibbò3
1Centro per le Malattie dell'Apparato Digerente (CEMAD), Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
Even with mucosal healing, ulcerative colitis patients with persistent histologic activity, specifically basal plasmacytosis and surface irregularity, face a higher risk of disease relapse.
Area of Science:
- Gastroenterology
- Inflammatory Bowel Disease Research
- Histopathology
Background:
- Mucosal healing (MH) is a primary treatment goal for ulcerative colitis (UC).
- Despite achieving MH, a subset of UC patients experience disease reactivation.
- Persistent histologic activity (HA) beyond endoscopic healing may predict relapse.
Purpose of the Study:
- To determine the prevalence of HA in UC patients with MH.
- To identify specific histological lesions associated with clinical relapse after achieving MH.
Main Methods:
- Retrospective enrollment of 100 UC patients with MH (Mayo Endoscopic Subscore 0-1).
- Review of histological biopsy reports for UC-related lesions.
- Assessment of clinical relapse rates within 12 months post-colonoscopy.
Main Results:
- Two patients had no histological lesions; 98 had some degree of HA.
- Univariate analysis linked higher lesion counts, basal plasmacytosis, lamina propria eosinophils, and surface irregularity to relapse risk.
- Multivariate analysis confirmed basal plasmacytosis (OR 2.98) and surface irregularity (OR 4.50) as significant predictors of relapse.
Conclusions:
- Histologic activity is present in a significant proportion of UC patients achieving mucosal healing.
- Basal plasmacytosis and surface irregularity are key histological indicators of increased relapse risk in UC patients with MH.
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