Rish K Pai1, Vipul Jairath2, Niels Vande Casteele3, Florian Rieder4, Claire E Parker5, Gregory Y Lauwers6. 1. Department of Pathology and Laboratory Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA. 2. Robarts Clinical Trials Inc., London, Ontario, Canada; Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada; Department of Medicine, University of Western Ontario, London, Ontario, Canada. 3. Robarts Clinical Trials Inc., London, Ontario, Canada; Department of Medicine, University of California, San Diego, La Jolla, California, USA. 4. Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA. 5. Robarts Clinical Trials Inc., London, Ontario, Canada. 6. Department of Anatomic Pathology, Moffitt Cancer Center, Tampa Bay, Florida, USA.
Abstract
BACKGROUND AND AIMS: Assessment of disease activity is essential for developing and determining appropriate therapy in patients with ulcerative colitis (UC). Validated clinical and endoscopic scoring systems have been established to accurately define disease activity. Clinical and endoscopic treatment targets have also been proposed, with gastroenterologists encouraged to optimize medical therapy to achieve these targets. Recently, histology has been recognized as an important prognostic factor and potential treatment target in patients with UC. METHODS: This review summarizes the recent literature regarding histologic scoring indices in UC and offers practical guidance to gastroenterologists on how to interpret histologic data. RESULTS: Substantial evidence indicates that histology accurately predicts clinical relapse, hospitalization, corticosteroid use, and development of dysplasia. Furthermore, compared with endoscopy, findings suggest that histology may be more predictive of these outcomes. Because microscopic disease activity can persist in the absence of clinical or endoscopic disease activity, histology may be the ideal marker of inflammation. Standardized definitions of histologic response and remission and a biopsy procurement protocol are needed to guide clinical decision making. It is recommended that overall assessment of disease severity be determined according to the worst affected biopsy fragment. Crypt architectural distortion, basal plasmacytosis, and neutrophilic activity should be reported. A 5-category classification system based on disease chronicity/activity and basal plasmacytosis is proposed. It is not yet necessary to report on the degree of mucosal eosinophilia or use a validated scoring system, although the latter may aid in determining therapeutic response. CONCLUSIONS: Although rarely used to measure inflammation and guide therapy, histologic disease activity is predictive of important clinical outcomes in UC. Randomized controlled trials are needed to determine whether histology should function as a treatment target.
BACKGROUND AND AIMS: Assessment of disease activity is essential for developing and determining appropriate therapy in patients with ulcerative colitis (UC). Validated clinical and endoscopic scoring systems have been established to accurately define disease activity. Clinical and endoscopic treatment targets have also been proposed, with gastroenterologists encouraged to optimize medical therapy to achieve these targets. Recently, histology has been recognized as an important prognostic factor and potential treatment target in patients with UC. METHODS: This review summarizes the recent literature regarding histologic scoring indices in UC and offers practical guidance to gastroenterologists on how to interpret histologic data. RESULTS: Substantial evidence indicates that histology accurately predicts clinical relapse, hospitalization, corticosteroid use, and development of dysplasia. Furthermore, compared with endoscopy, findings suggest that histology may be more predictive of these outcomes. Because microscopic disease activity can persist in the absence of clinical or endoscopic disease activity, histology may be the ideal marker of inflammation. Standardized definitions of histologic response and remission and a biopsy procurement protocol are needed to guide clinical decision making. It is recommended that overall assessment of disease severity be determined according to the worst affected biopsy fragment. Crypt architectural distortion, basal plasmacytosis, and neutrophilic activity should be reported. A 5-category classification system based on disease chronicity/activity and basal plasmacytosis is proposed. It is not yet necessary to report on the degree of mucosal eosinophilia or use a validated scoring system, although the latter may aid in determining therapeutic response. CONCLUSIONS: Although rarely used to measure inflammation and guide therapy, histologic disease activity is predictive of important clinical outcomes in UC. Randomized controlled trials are needed to determine whether histology should function as a treatment target.
Authors: David Chen; Clifton Fulmer; Ilyssa O Gordon; Sana Syed; Ryan W Stidham; Niels Vande Casteele; Yi Qin; Katherine Falloon; Benjamin L Cohen; Robert Wyllie; Florian Rieder Journal: J Crohns Colitis Date: 2022-03-14 Impact factor: 10.020
Authors: Christopher Ma; William J Sandborn; Geert R D'Haens; Guangyong Zou; Larry W Stitt; Siddharth Singh; Ashwin N Ananthakrishnan; Parambir S Dulai; Reena Khanna; Vipul Jairath; Brian G Feagan Journal: Clin Gastroenterol Hepatol Date: 2019-09-20 Impact factor: 11.382
Authors: Christopher Ma; Rocio Sedano; Ahmed Almradi; Niels Vande Casteele; Claire E Parker; Leonardo Guizzetti; David F Schaeffer; Robert H Riddell; Reetesh K Pai; Robert Battat; Bruce E Sands; Christophe Rosty; Marla C Dubinsky; Florian Rieder; Noam Harpaz; Maria T Abreu; Robert V Bryant; Gregory Y Lauwers; Richard Kirsch; Mark A Valasek; Eileen Crowley; William J Sandborn; Brian G Feagan; Rish K Pai; Vipul Jairath Journal: Gastroenterology Date: 2021-02-19 Impact factor: 22.682