Fernando Magro1, Catarina Alves2, Joanne Lopes3, Susana Lopes4, Helena Tavares de Sousa5, José Cotter6, Vitor Macedo da Silva7, Paula Lago8, Ana Vieira9, Mariana Brito9, Maria A M Duarte10, Francisco Portela11, João P Silva12, Paula Ministro13, Bruno Arroja14, Liliana Carvalho15, Joana Torres16, Mafalda Santiago17, Maria Manuela Estevinho18, Silvio Danese19, Laurent Peyrin-Biroulet20, Cláudia Camila Dias21, Paula Borralho22, Roger M Feakins23, Fátima Carneiro24. 1. Department of Gastroenterology, São João University Hospital Center (CHUSJ), Porto, Portugal; Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal; Department of Clinical Pharmacology, São João University Hospital Center (CHUSJ), Porto, Portugal. Electronic address: fm@med.up.pt. 2. Faculty of Medicine, University of Porto, Porto, Portugal. 3. Department of Pathology, São João University Hospital Center (CHUSJ), Porto, Portugal. 4. Department of Gastroenterology, São João University Hospital Center (CHUSJ), Porto, Portugal. 5. Department of Gastroenterology, Algarve Hospital University Center-Portimão Unit, Portimão, Portugal; ABC - Algarve Biomedical Center, University of Algarve, Faro, Portugal. 6. Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal; Life and Health Sciences Research Institute (ICVS), School of Medicine - University of Minho, Braga, Portugal; ICVS/3B's PT Government Associate Laboratory, Braga/Guimarães, Portugal. 7. Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal. 8. Department of Gastroenterology, Porto Hospital Center, Hospital de Santo António, Porto, Portugal. 9. Department of Gastroenterology, Garcia de Orta Hospital, Almada, Portugal. 10. Department of Gastroenterology, Divino Espírito Santo Hospital, Ponta Delgada, Portugal. 11. Gastroenterology Department, University Hospital Center of Coimbra, Coimbra, Portugal. 12. Gastroenterology Department, Portuguese Institute of Oncology of Lisbon, Lisboa, Portugal. 13. Department of Gastroenterology, Tondela-Viseu Hospital Center, Viseu, Portugal. 14. Department of Gastroenterology, Braga Hospital, Braga, Portugal. 15. Department of Gastroenterology, Lisbon Ocidental Hospital Center, Lisboa, Portugal. 16. Department of Gastroenterology, Beatriz Ângelo Hospital, Loures, Portugal. 17. Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal. 18. Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal. 19. Department of Biomedical Sciences, Humanitas University, Milan, Italy; Inflammatory Bowel Disease (IBD) Center, Department of Gastroenterology, Humanitas Clinical and Research Center (IRCCS), Milan, Italy. 20. Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France. 21. Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal. 22. Institute of Pathology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal. 23. Department of Histopathology, Royal Free Hospital, London, United Kingdom. 24. Department of Pathology, São João University Hospital Center (CHUSJ), Porto, Portugal; Institute of Molecular Pathology and Immunology of the University of Porto (Ipatimup), University of Porto, Porto, Portugal.
Abstract
BACKGROUND & AIMS: In addition to findings from endoscopy, histologic features of colon biopsies have been associated with outcomes of patients with ulcerative colitis (UC). We investigated associations between Geboes scores (a system to quantify structural changes and inflammatory activity in colon biopsies) and UC progression, and the time period over which this association is valid. METHODS: We analyzed data from 399 asymptomatic patients with UC enrolled in the ACERTIVE study, followed at 13 inflammatory bowel disease (IBD) centers in Portugal through 31 December 2019. Blood and stool samples were collected and analyzed, and all patients underwent sigmoidoscopy within 24 h of sample collection. We assessed baseline endoscopic status (Mayo endoscopic subscore), histologic features of 2 sigmoid and 2 rectal biopsies (Geboes score), and concentration of fecal calprotectin (FC). The primary outcome was UC progression (surgical, pharmacologic, and clinical events). We generated survival curves for 36 months or less and more than 36 months after biopsy according to Geboes score using the Kaplan-Meier method and compared findings with those from a log rank test. Cox regression was adjusted for Mayo endoscopic subscore, Geboes score, and level of FC; results were expressed as adjusted hazard ratios (HR) with 95% CIs. RESULTS: Patients with Geboes scores >2B.0, Geboes scores >3.0, or Geboes scores >4.0 had a higher frequency of, and a shorter time to UC progression, than patients with Geboes scores ≤2B.0, Geboes scores ≤3.0, or Geboes score ≤4.0 (P < .001). Disease progression occurred earlier in patients with Geboes scores >2B.0, Geboes scores >3.0, or Geboes scores >4.0 compared with patients with Geboes scores ≤2B.0 (HR, 2.021; 95% CI, 1.158-3.526), Geboes scores ≤3.0 (HR, 2.007; 95% CI, 1.139-3.534), or Geboes scores ≤4.0 (HR, 2.349; 95% CI, 1.269-4.349), respectively, in the first 36 months after biopsy. Similar results were found for patients with concentrations of FC below 150 μg/g. CONCLUSIONS: We found histologic features of colon biopsies (Geboes score) to be an independent risk factor for progression of UC in the first 36 months after biopsy.
BACKGROUND & AIMS: In addition to findings from endoscopy, histologic features of colon biopsies have been associated with outcomes of patients with ulcerative colitis (UC). We investigated associations between Geboes scores (a system to quantify structural changes and inflammatory activity in colon biopsies) and UC progression, and the time period over which this association is valid. METHODS: We analyzed data from 399 asymptomatic patients with UC enrolled in the ACERTIVE study, followed at 13 inflammatory bowel disease (IBD) centers in Portugal through 31 December 2019. Blood and stool samples were collected and analyzed, and all patients underwent sigmoidoscopy within 24 h of sample collection. We assessed baseline endoscopic status (Mayo endoscopic subscore), histologic features of 2 sigmoid and 2 rectal biopsies (Geboes score), and concentration of fecal calprotectin (FC). The primary outcome was UC progression (surgical, pharmacologic, and clinical events). We generated survival curves for 36 months or less and more than 36 months after biopsy according to Geboes score using the Kaplan-Meier method and compared findings with those from a log rank test. Cox regression was adjusted for Mayo endoscopic subscore, Geboes score, and level of FC; results were expressed as adjusted hazard ratios (HR) with 95% CIs. RESULTS: Patients with Geboes scores >2B.0, Geboes scores >3.0, or Geboes scores >4.0 had a higher frequency of, and a shorter time to UC progression, than patients with Geboes scores ≤2B.0, Geboes scores ≤3.0, or Geboes score ≤4.0 (P < .001). Disease progression occurred earlier in patients with Geboes scores >2B.0, Geboes scores >3.0, or Geboes scores >4.0 compared with patients with Geboes scores ≤2B.0 (HR, 2.021; 95% CI, 1.158-3.526), Geboes scores ≤3.0 (HR, 2.007; 95% CI, 1.139-3.534), or Geboes scores ≤4.0 (HR, 2.349; 95% CI, 1.269-4.349), respectively, in the first 36 months after biopsy. Similar results were found for patients with concentrations of FC below 150 μg/g. CONCLUSIONS: We found histologic features of colon biopsies (Geboes score) to be an independent risk factor for progression of UC in the first 36 months after biopsy.