Integrated Assessment of Intestinal Barrier Function and Microscopic Inflammation Using Confocal Laser Endomicroscopy...

Area of Science:

• Gastroenterology
• Inflammatory Bowel Disease Research
• Medical Imaging and Diagnostics

Background:

• Current ulcerative colitis (UC) management targets endoscopic healing, but microscopic inflammation and barrier dysfunction increase relapse risk.
• Identifying patients at high risk for relapse is crucial for optimizing UC treatment strategies.

Purpose of the Study:

• To evaluate if probe-based confocal laser endomicroscopy (pCLE) can identify structural and functional mucosal abnormalities predicting loss of therapeutic targets in UC.
• To assess the prognostic value of pCLE in predicting clinical and endoscopic relapse in UC patients.

Main Methods:

• Prospective single-center study of 81 UC patients in clinical and endoscopic remission over 24 months.
• Baseline assessment included colonoscopy with pCLE and biopsies for histological inflammation (HI) and barrier dysfunction in the ileum and colon.
• Clinical evaluations were conducted every 3 months.

Main Results:

• Altered colonic permeability (OR=3.85) and pCLE-detected HI (OR=6.04) predicted loss of endoscopic remission.
• Altered ileal (HR=6.01) or colonic (HR=6.51) barrier function increased clinical relapse risk.
• Triple healing (histological healing, intact ileal and colonic permeability) at baseline predicted no relapse.

Conclusions:

• pCLE provides superior prognostic value for predicting UC relapse compared to standard assessments.
• Morphological and functional evaluation via pCLE may serve as a therapeutic target for preventing UC relapses.
• Achieving triple healing is associated with sustained remission in UC patients.