Impact of histological healing on ulcerative colitis disease course among patients with endoscopic healing: results of a prospective study - 01/10/25
, Camille Robert a, Franck Brazier a, Erica Meudjo a, Capucine Moreau a, Denis Chatelain b, Mathurin Fumery a, cHighlights |
• | Histological healing is associated with improved longterm outcome in UC patients whatever the degree of endoscopic mucosal healing. |
• | Rectal biopsies are effective in identifying histological healing. |
Abstract |
Background |
The STRIDE II guidelines recognize endoscopic healing (EH) as one of the main therapeutic goals in ulcerative colitis (UC). Nevertheless, histological healing (HH) could reduce the risk of long-term complications in UC. The aim of this study was to assess the risk of relapse in UC depending on the degree of remission achieved.
Methods |
We conducted a prospective study including all consecutive UC patients in clinical remission and EH (MES 0 or 1) between January 2021 and January 2024. The primary endpoint was UC relapse, defined as the need for treatment intensification and/or corticosteroids initiation and/or UC-related hospitalization and/or colectomy. Patients were followed up every 6 months for two years. HH was defined as a Nancy index ≤ 1 (blinded double reading).
Results |
A total of 75 patients were included. The median disease duration was 12 years (IQR [7.5–19.0]) and 66 (82 %) patients had a left side colitis (E2) or pancolitis (E3). Patients were treated for a median of 3 years (IQR [1.2 - 6.9]) prior to colonoscopy, 49 (65 %) patients had MES 0. Fifty-nine (79 %) patients of the cohort had HH. After a median follow-up of 21.0 months (IQR [12.0 - 26.5]), relapse was observed in 13 patients (17 %) after a median delay of 11 months (IQR [6.0 - 18.0]). There was no difference in the risk of relapse between patients with MES 1 and MES (13.6 % vs. 30.7 % respectively p = 0.275). The risk of relapse in patient with MES 1 was significantly higher among patient with absence of HH (39.7 % versus 20.1 % respectively p = 0.04). Similarly, in patients with MES 0, the risk of relapse was significantly higher among patients without HH (70.0 % versus 27.4 % respectively, p = 0.023). No UC-related hospitalizations or colectomy were reported during follow-up. In multivariate analysis, absence of HH was the only factor associated with disease relapse (HR 4.55 [1.69; 12.22], p = 0.0118).
Conclusion |
In this prospective cohort, histological healing was the only associated with improved long-term outcome in UC patients whatever the degree of endoscopic mucosal healing.
Le texte complet de cet article est disponible en PDF.Keywords : Abbreviations: UC, Ulcerative colitis, EH, endoscopic healing, HH, histological healing, RS, rectosigmoidoscopy
Plan
Vol 49 - N° 9
Article 102700- novembre 2025 Retour au numéro
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