Histology grade can help predict relapse in ulcerative colitis

Last Updated: 2016-03-25

By David Douglas

NEW YORK (Reuters Health) - In ulcerative colitis (UC) patients in remission, histological inflammation measures are effective predictors of relapse, according to Massachusetts-based researchers.

"This study suggests that the histological findings may have greater prognostic value for patients with UC than the endoscopic appearance that we currently rely on," Dr. Alan C. Moss of Beth Israel Deaconess Medical Center, Boston, told Reuters Health by email.

Dr. Moss and colleagues, whose findings appeared online March 15 in the American Journal of Gastroenterology, evaluated the association between Mayo endoscopic scores and histological grades (Geboes) and the risk of future clinical relapse.

The researchers enrolled 179 subjects in whom endoscopic scores and histological grades and blood markers were collected. Over 12 months, 42 (23%) showed clinical relapse, 5% were hospitalized and 2% underwent colectomy.

In univariate analysis both the Mayo and Geboes indicators were significant predictors of clinical relapse. However, in a multivariate model that included mesalamine use, white cell count, endoscopy score, and histology grade, only the histology grade remained significant.

In subjects whose baseline Geboes grade was 3.1 or more, the relative risk of clinical relapse was 3.5. This amounted to a sensitivity of 74%, a specificity of 67%, and a positive predictive value of 40% for clinical relapse.

Among possible reasons for the better prediction with the histological grade, the researchers say, are that "the abnormalities seen at the microscopic level may reflect local molecular changes that influence symptoms such as diarrhea, even when the endoscopic appearance is near-normal."

Despite the apparent utility of the approach, the team adds, "Whether histological healing is an achievable and a cost-effective goal of UC therapy will need further study."

SOURCE: bit.ly/1RALpT7

Am J Gastroenterol 2016.