Rish K Pai1, Douglas J Hartman2, Claudia Ramos Rivers3, Miguel Regueiro4, Marc Schwartz3, David G Binion3, Reetesh K Pai5. 1. Department of Pathology and Laboratory Medicine, Mayo Clinic Arizona, Scottsdale, Arizona. 2. Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 3. Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 4. Division of Gastroenterology, Cleveland Clinic, Cleveland, Ohio. 5. Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Electronic address: pair@upmc.edu.
Abstract
BACKGROUND & AIMS: We investigated correlations between histologic features of the colonic mucosa in patients with ulcerative colitis (UC) and clinical outcomes during a 3-year follow-up period. METHODS: We obtained baseline biopsies from all colorectal segments (n = 889) from 281 patients with UC enrolled in a prospective study at a single center from 2009 through 2013. Biopsies were assessed in a blinded manner using validated histologic scoring systems (the Geboes score, Nancy histopathologic index, and Robarts histopathologic index). Clinical, endoscopic, and histologic data were collected and tested for correlations with systemic corticosteroid use, hospitalization, and colectomy within 3 years of the index colonoscopy. RESULTS: We found histologic evidence of UC activity (Geboes score ≥ 2B.1) in biopsies from 182 patients (65%) and endoscopic evidence of UC activity in 149 patients (53%) (substantial agreement, κ = 0.60). Histologic features of UC activity were associated with increased rates of systemic corticosteroid use, colectomy, and hospitalization in the entire cohort (P < .05 for all) and associated with increased rates of systemic corticosteroid use in an analysis limited to patients in endoscopic remission (P < .001). In patients in endoscopic remission, only histologic activity was independently associated with use of systemic corticosteroids (multivariate odds ratio, 6.34; 95% CI, 2.20-18.28; P = .001). Similar results were seen when the entire cohort was analyzed. Compared with patients without histologic evidence of UC activity, patients with only a small number of mucosal neutrophils still had higher rates of systemic corticosteroid use (P < .001). CONCLUSIONS: Histologic evidence of UC activity, including small numbers of neutrophils in the colonic mucosa, is the only factor independently associated with use of systemic corticosteroids. Complete resolution of neutrophil-associated inflammation should be a target for treatment of UC.
BACKGROUND & AIMS: We investigated correlations between histologic features of the colonic mucosa in patients with ulcerative colitis (UC) and clinical outcomes during a 3-year follow-up period. METHODS: We obtained baseline biopsies from all colorectal segments (n = 889) from 281 patients with UC enrolled in a prospective study at a single center from 2009 through 2013. Biopsies were assessed in a blinded manner using validated histologic scoring systems (the Geboes score, Nancy histopathologic index, and Robarts histopathologic index). Clinical, endoscopic, and histologic data were collected and tested for correlations with systemic corticosteroid use, hospitalization, and colectomy within 3 years of the index colonoscopy. RESULTS: We found histologic evidence of UC activity (Geboes score ≥ 2B.1) in biopsies from 182 patients (65%) and endoscopic evidence of UC activity in 149 patients (53%) (substantial agreement, κ = 0.60). Histologic features of UC activity were associated with increased rates of systemic corticosteroid use, colectomy, and hospitalization in the entire cohort (P < .05 for all) and associated with increased rates of systemic corticosteroid use in an analysis limited to patients in endoscopic remission (P < .001). In patients in endoscopic remission, only histologic activity was independently associated with use of systemic corticosteroids (multivariate odds ratio, 6.34; 95% CI, 2.20-18.28; P = .001). Similar results were seen when the entire cohort was analyzed. Compared with patients without histologic evidence of UC activity, patients with only a small number of mucosal neutrophils still had higher rates of systemic corticosteroid use (P < .001). CONCLUSIONS: Histologic evidence of UC activity, including small numbers of neutrophils in the colonic mucosa, is the only factor independently associated with use of systemic corticosteroids. Complete resolution of neutrophil-associated inflammation should be a target for treatment of UC.
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
Authors: Olga Maria Nardone; Alina Bazarova; Pradeep Bhandari; Rosanna Cannatelli; Marco Daperno; Jose Ferraz; Martin Goetz; Xianyong Gui; Bu Hayee; Gert De Hertogh; Mark Lazarev; Ji Li; Adolfo Parra-Blanco; Luca Pastorelli; Remo Panaccione; Vincenzo Occhipinti; Timo Rath; Samuel C L Smith; Uday N Shivaji; Gian Eugenio Tontini; Michael Vieth; Vincenzo Villanacci; Davide Zardo; Raf Bisschops; Ralf Kiesslich; Subrata Ghosh; Marietta Iacucci Journal: United European Gastroenterol J Date: 2022-02-23 Impact factor: 4.623
Authors: Corinna Lang-Schwarz; Abbas Agaimy; Raja Atreya; Christoph Becker; Silvio Danese; Jean-François Fléjou; Nikolaus Gaßler; Heike I Grabsch; Arndt Hartmann; Kateřina Kamarádová; Anja A Kühl; Gregory Y Lauwers; Alessandro Lugli; Iris Nagtegaal; Markus F Neurath; Georg Oberhuber; Laurent Peyrin-Biroulet; Timo Rath; Robert Riddell; Carlos A Rubio; Kieran Sheahan; Herbert Tilg; Vincenzo Villanacci; Maria Westerhoff; Michael Vieth Journal: Virchows Arch Date: 2020-12-29 Impact factor: 4.064
Authors: Corinna Lang-Schwarz; Miriam Angeloni; Abbas Agaimy; Raja Atreya; Christoph Becker; Theresa Dregelies; Silvio Danese; Jean-François Fléjou; Nikolaus Gaßler; Heike I Grabsch; Arndt Hartmann; Kateřina Kamarádová; Anja A Kühl; Gregory Y Lauwers; Alessandro Lugli; Iris Nagtegaal; Markus F Neurath; Georg Oberhuber; Laurent Peyrin-Biroulet; Timo Rath; Robert Riddell; Carlos A Rubio; Kieran Sheahan; Britta Siegmund; Herbert Tilg; Vincenzo Villanacci; Maria Westerhoff; Fulvia Ferrazzi; Michael Vieth Journal: J Crohns Colitis Date: 2021-10-07 Impact factor: 9.071