Increased neutrophils in the colonic mucosa of patients with ulcerative colitis (UC) were associated with increased use of systemic corticosteroids, colectomy, and hospitalization during 3 years of follow-up, according to a new study published in Clinical Gastroenterology and Hepatology.1
In colon biopsies from patients with UC, specific histologic features have been associated with adverse outcomes. To investigate correlations between histologic features of the colonic mucosa in patients with UC and clinical outcomes over a 3-year follow-up period, researchers collected biopsies from all colorectal segments (n = 889) from patients with UC (n = 281) who enrolled in a prospective study at the University of Pittsburgh Medical Center from 2009 to 2013.1,2
Histologic assessment of the biopsies was performed using 3 validated scoring systems: the Geboes score, Nancy histopathologic index, and Robarts histopathologic index. Biopsies were subclassified as histologic remission and histologic activity. Remission or activity was also assessed based on endoscopic features using the modified Mayo endoscopic scoring system. Patients’ clinical records were reviewed for data on inflammatory bowel disease medications (5-aminosalicylate compounds, immunomodulators, antitumor necrosis factor [anti-TNF], and systemic corticosteroids), hospitalizations, and colectomy within 3 years of the index colonoscopic evaluation. Histologic features were then tested for correlations with systemic corticosteroid use, hospitalization, and colectomy.
Of the 281 patients, histologic and endoscopic evidence of UC activity was observed in biopsies from 65% and 53% of patients, respectively, with agreement between the two (k = 0.60). Baseline histologic and endoscopic activities were associated with systemic corticosteroid use (P <.001 and P =.002, respectively) and higher rates of colectomy (P =.046 and P =.001, respectively). Histologic activity was associated with a higher hospitalization rate (P =.047) and was independently associated with systemic corticosteroid use in patients in endoscopic remission (multivariate odds ratio, 6.34; 95% CI: 2.20-18.28; P =.001).
Patients in endoscopic remission were further subdivided into 3 groups: histologic remission, histologic near remission (only a small number of mucosal neutrophils), and histologic activity (more than a small number of mucosal neutrophils). Patients in near histologic remission had higher rates of systemic corticosteroid use than patients in histologic remission (58% vs 22%, P =.006).
Limitations included the use of endoscopic reports to obtain endoscopic activity, a lack of standardization of biopsy procurement, and unavailable data on prior episodes of clinical relapse and duration of clinical remission prior to the index colonoscopy/inclusion in the study.
The authors concluded, “This study demonstrates the prognostic importance of histologic disease activity assessment in UC,” and these results indicate that “complete resolution of neutrophil-associated inflammation should be a target for treatment of UC.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures. None of the authors have any potential personal conflicts of interest.
1. Pai RK, Hartman DJ, Rivers CR, et al. Complete resolution of mucosal neutrophils associates with improved long-term clinical outcomes of patients with ulcerative colitis [published online December 13, 2019]. Clin Gastroenterol Hepatol. doi:10.1016/j.cgh.2019.12.011
2. Anderson AJ, Click B, Ramos-Rivers C, et al. Development of an inflammatory bowel disease research registry derived from observational electronic health record data for comprehensive clinical phenotyping. Dig Dis Sci. 2016;61(11):3236-3245. doi:10.1007/s10620-016-4278-z