Histological activity predicts relapse in pediatric ulcerative colitis despite mucosal healing: a multicenter study
Ivana Trivić Mažuranić1, Marina Aloi2,3, Matteo Bramuzzo4
1Referral Centre for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia.
Insights
Histological activity in children with ulcerative colitis (UC) and mucosal healing is a risk factor for relapse. Achieving histological remission, not just mucosal healing, is crucial for preventing UC flare-ups.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Gastrointestinal Histopathology
Background:
- Current ulcerative colitis (UC) treatment guidelines, like STRIDE-II, prioritize mucosal healing.
- Emerging evidence highlights histological remission as a more significant therapeutic target in UC management.
- The clinical implication of residual histological activity in pediatric UC patients achieving mucosal healing requires further investigation.
Purpose of the Study:
- To assess the association between persistent histological activity and the risk of subsequent relapse in pediatric UC patients who have achieved mucosal healing.
- To determine if histological remission, beyond endoscopic mucosal healing, impacts relapse rates in children with UC.
- To identify histological parameters predictive of relapse in pediatric UC.
Main Methods:
- A multicenter, retrospective cohort study involving 19 IBD centers across 9 countries.
- Included pediatric patients diagnosed with UC between January 2012 and December 2022, with follow-up endoscopy showing mucosal healing and available histology scores.
- Histological remission defined by Nancy index (NI) ≤1, Geboes score (GS) ≤2, or Robarts Histopathology Index (RHI) ≤3; histological healing defined as a score of 0.
Main Results:
- The study included 193 children (mean age 10.8 years, 66% female).
- At endoscopy, 80% achieved histological remission and 55% achieved histological healing.
- During a median follow-up of 2.4 years, 34% experienced relapse. Patients with histological healing had significantly lower relapse rates (27% vs. 41%; P=.031). Absence of histological remission (HR 0.499) and histological healing (HR 0.469) were associated with higher relapse risk.
Conclusions:
- Histological activity, even in the presence of mucosal healing, is a significant risk factor for UC relapse in children.
- Achieving complete histological remission is crucial for preventing future relapses in pediatric UC patients.
- These findings support the integration of histological assessment into UC treatment strategies for children.
Background And Aims:
The STRIDE-II recommends mucosal healing as a treatment goal for patients with ulcerative colitis (UC), yet histological remission is increasingly recognized as a meaningful therapeutic target. This study aims to evaluate whether histological activity among patients with mucosal healing is associated with the risk of subsequent relapse.
Methods:
A multicenter, retrospective cohort study comprised of 19 IBD centers from 9 countries. The study included children diagnosed with UC from January 2012 to December 2022 who had a follow-up endoscopy demonstrating mucosal healing and for whom histology scores were available. Histological remission was defined as a Nancy index (NI) ≤ 1, a Geboes score (GS) ≤ 2, or a Robarts Histopathology Index (RHI) ≤ 3. Histological healing was defined as a histological score of 0.
Results:
We included 193 children (mean age at diagnosis 10.8 ± 4.3 years; 128 [66%] female). At endoscopy, 155 (80%) children were in histological remission, and 107 (55%) had histological healing. During a median follow-up of 2.4 (range 1-8.7) years, 65 (34%) children experienced a relapse. Patients with histological healing had lower relapse rates than those with residual histological activity (27% vs. 41%; P = .031). Cox regression analysis showed that the absence of histological remission was significantly associated with a higher risk of relapse during follow-up (hazard ratio [HR] 0.499, 95% confidence interval [CI] 0.289-0.863, P = .013), with an even stronger association in those without histological healing (HR 0.469, 95% CI 0.284-0.773, P = .003).
Conclusion:
Histological activity is a risk factor for relapse of UC in children with mucosal healing.
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