Segmental Histologic Normalization Does Not Improve Ulcerative Colitis Outcomes

ulcerative colitis
ulcerative colitis
Segmental histologic normalization did not improve clinical outcomes of ulcerative colitis.

Segmental histologic normalization did not improve clinical outcomes of ulcerative colitis (UC), reported a retrospective cohort study published in the Journal of Crohn’s and Colitis.

Medical records were collected from individuals with confirmed UC (N=646) who had more than 1 instance of endoscopic surveillance with biopsies from the rectum, left, and right colon between 2005 and 2013. Histologic normalization was assessed in 3 segments of the gastrointestinal tract (rectum, left-, and right-side).

Compared with each patient’s maximum disease extent, 32% of patients exhibited segmental histologic normalization and 10% exhibited complete normalization. Of the segmental normalization group, 88% had a proximal-to-distal normalization pattern. The investigators reported that segmental histological normalization was significantly correlated with current use of tobacco (P =.04) and age of diagnosis (≤16 years of age; P =.028).

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Nearly half of study participants (n=310) were in clinical remission at the time of their final colonoscopy, however a quarter (n=77) of them had a relapse of UC symptoms at a median time of 1.3 years.

To assess improvement in relapse-free survival, investigators calculated hazard ratios (HR) of cohorts against the patients who did not achieve any normalization. They found that only individuals who achieved complete normalization were significantly improved: distal or patchy histologic normalization HR 1.43 (95% CI, 0.43-4.73; P =.353), proximal histologic normalization HR 0.66 (0.34-1.29; P =.226), and complete histologic normalization HR 0.23 (95% CI, 0.08-0.68; P =.008).

A limitation of this study is that information on dose and duration of therapy was unavailable. As treatment regime is an important factor in causing partial or complete histologic normalization, these factors could have an underlying effect on the presented results.

The study authors concluded that while segmental normalization in patients with UC was more common (32%) than complete normalization (10%), only the patients who achieved complete normalization had improved clinical outcomes.

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Christensen B, Hanauer S B, Gibson P R, et al. Segmental histologic normalization occurs in ulcerative colitis but does not improve clinical outcomes [available online April 8, 2020] J Crohns Colitis doi:10.1093/ecco-jcc/jjaa068.