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Histological Inflammation in the Endoscopically Uninflamed Mucosa is Associated With Worse Outcomes in Limited Ulcerative Colitis

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  • Catarina Geraldes de Frias Gomes
  • Alexandra Sofia Ribeiro de Almeida
  • Catarina Callé Lucas Mendes
  • Pierre Ellul
  • Johan Burisch
  • Tiffany Buhagiar
  • Abigail Attard
  • Bobby Lo
  • Ryan C Ungaro
  • Bárbara Tonilhas da Silva Morão
  • Catarina Ferreira Gouveia
  • Joana Milheiro Delgado de Carvalho E Branco
  • Jaime Manuel Martins Pereira Rodrigues
  • Cristina Teixeira
  • Maria Francisca Faria Dias de Castro
  • Gonçalo Filipe Domingos Nunes
  • Mariana Brito
  • Marília Cristina de Sousa Antunes
  • Paula Maria Ferreira Brinca Borralho Nunes
  • Joana Maria Tinoco da Silva Torres
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BACKGROUND: The Montreal classification categorizes patients with ulcerative colitis (UC) based on their macroscopic disease extent. Independent of endoscopic extent, biopsies through all colonic segments should be retrieved during index colonoscopy. However, the prognostic value of histological inflammation at diagnosis in the inflamed and uninflamed regions of the colon has never been assessed.

METHODS: This was a multicenter retrospective cohort study of newly diagnosed patients with treatment-naïve proctitis and left-sided UC. Biopsies from at least 2 colonic segments (endoscopically inflamed and uninflamed mucosa) were retrieved and reviewed by 2 pathologists. Histological features in the endoscopically inflamed and uninflamed mucosa were scored using the Nancy score. The primary outcomes were disease complications (proximal disease extension, need for hospitalization or colectomy) and higher therapeutic requirements (need for steroids or for therapy escalation).

RESULTS: Overall, 93 treatment-naïve patients were included, with a median follow-up of 44 months (range, 2-329). The prevalence of any histological inflammation above the endoscopic margin was 71%. Proximal disease extension was more frequent in patients with histological inflammation in the endoscopically uninflamed mucosa at diagnosis (21.5% vs 3.4%, P = 0.04). Histological involvement above the endoscopic margin was the only predictor associated with an earlier need for therapy escalation (adjusted hazard ratio, 3.69; 95% confidence interval, 1.05-13.0); P = 0.04) and disease complications (adjusted hazard ratio, 4.79; 95% confidence interval, 1.10-20.9; P = 0.04).

CONCLUSIONS: The presence of histological inflammation in the endoscopically uninflamed mucosa at the time of diagnosis was associated with worse outcomes in limited UC.

OriginalsprogEngelsk
Artikelnummerizab069
TidsskriftInflammatory Bowel Diseases
Vol/bind28
Udgave nummer3
Sider (fra-til)350-357
Antal sider8
ISSN1078-0998
DOI
StatusUdgivet - 2 mar. 2022

ID: 65655170