Histologic healing and clinical outcomes in ulcerative colitis

Area of Science:

• Gastroenterology
• Inflammatory Bowel Disease Research
• Clinical Outcomes Research

Background:

• Growing evidence suggests histologic healing (HH) in ulcerative colitis (UC) improves clinical outcomes beyond endoscopic healing (EH).
• Data on HH's impact in Asian UC patients is limited.
• This study investigates the association between HH and clinical outcomes in this population.

Purpose of the Study:

• To evaluate if histologic healing (HH) is associated with better clinical outcomes in Asian ulcerative colitis (UC) patients.
• To assess predictors of clinical relapse (CRL) and histologic healing (HH).

Main Methods:

• Retrospective study of UC patients in clinical remission (CR) with follow-up colonoscopy.
• Primary outcome: clinical relapse (CRL) defined by Simple Clinical Colitis Activity Index, medication escalation, hospitalization, or colectomy.
• Analysis of predictors for CRL and HH.

Main Results:

• Among 80 patients in endoscopic remission (EH), 42.5% had persistent histologic activity.
• Patients achieving HH had significantly lower CRL rates (26.1% vs. 50.0%) and longer CRL-free survival.
• Multivariable analysis indicated Mayo endoscopic score (MES) 0 was the sole predictor of lower CRL risk.

Conclusions:

• Histologic healing (HH) improves clinical outcomes in Asian UC patients, beyond clinical remission (CR) and endoscopic healing (EH).
• The incremental benefit of HH may be diminished when MES 0 is achieved.
• Further prospective studies are needed to guide therapy based on histologic findings.