Histologic Remission With NHI Effective for Predicting Relapse-Free Survival in Ulcerative Colitis

ulcerative colitis
A team of researchers assessed histologic activity in patients with ulcerative colitis who were in endoscopic and clinical remission, using the NHI score to predict future relapse.

Among patients with ulcerative colitis (UC) with clinical and endoscopic remission, histologic remission using the Nancy histologic index (NHI) can predict significantly longer relapse-free survival, according to study results published in the Journal of Clinical Gastroenterology.

For the analysis, researchers performed a retrospective cohort study, which included patients with UC who visited an inflammatory bowel disease clinic at a single tertiary center between 2015 and 2018. Eligible participants had an established diagnosis of UC per endoscopic and histologic criteria and a complete colonoscopy between 2009 and 2017.

Clinical remission was defined as a partial Mayo score (MSp) lower than 2, and endoscopic remission was defined as a Mayo endoscopic subscore (MES) of 1 or lower. Histologic remission was defined according to an NHI score of 0 or 1, and histologic activity was defined by a score of 2 to 4.

The study included a total of 74 patients, all of which achieved both clinical and endoscopic remission during surveillance colonoscopy. Study participants had a median age of 41 (IQR, 32-53) years, 57% were men, and the median disease duration was 8 (IQR, 4-16) years at time of surveillance colonoscopy. The median follow-up was 42 (IQR, 26-63) months, and the median relapse-free period was 29.8 (IQR, 17.5-47.7) months.

A total of 33 (45%) patients relapsed, of whom 7 were hospitalized. Clinical relapse was comparable between patients with MES 0 and those with MES 1, with rates of 40% (19/47) and 52% (14/27), respectively (P =.46). Further, 29% (12/41) of patients in histologic remission at baseline had a relapse vs 64% (21/33) with histologic activity at baseline (P =.0046).

Patients with MES 0 vs MES 1 (P <.02) and participants with histologic remission (NHI 0 to 1) vs histologic activity (NHI 2 to 4) had increased relapse-free survival, according to Kaplan-Meier analysis (P <.0001).

Multivariate analysis showed that histologic activity was the only independent risk factor for relapse (hazard ratio, 4.36; 95% CI, 1.68-11.27; P =.002).

Among several study limitations, clinical and endoscopic variables were obtained from electronic medical records in a tertiary referral center and did not contain objective relapse measures. Colonic biopsies were also not standardized, and the study was not powered to detect differences regarding dysplasia and colectomy.

“Our study demonstrates histologic remission using the validated NHI is an important prognostic marker in UC patients with clinical and endoscopic remission, and predicts longer relapse-free survival,” the researchers commented. “Histologic activity remains the only predictor of relapse in this cohort and is present in a significant proportion of patients in endoscopic remission.”


Wang H, Fewings I, Bornman L, Shadbolt B, Fadia M, Subramaniam K. Histologic remission (NANCY index) is superior to endoscopic mucosal healing in predicting relapse free survival in patients with ulcerative colitis in clinical and endoscopic remission. J Clin Gastroenterol. Published online February 28, 2022. doi:10.1097/MCG.0000000000001681