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Onwuka E, Huntington J, Onwuka A, Prasad V, Nwomeh B. Acute histologic inflammatory activity and postoperative outcomes in pediatric patients with ulcerative colitis. Am J Surg 2020; 219:592-597. [PMID: 32209240 DOI: 10.1016/j.amjsurg.2020.02.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/23/2019] [Accepted: 02/27/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to determine whether acute histologic inflammatory activity at the rectal margin predicts postoperative complications in children with ulcerative colitis following ileal pouch-anal anastomoses (IPAA). METHODS Patients who underwent IPAA following previous total abdominal colectomy for ulcerative colitis between 2006 and 2014 were included. Data collected included demographics, operative and postoperative data, histologic grading of the rectal margin at time of IPAA, and stooling outcomes at one, six and 12 months following ileostomy closure. RESULTS Twenty-seven patients were included. Acute inflammation scores ranged between 2 and 13. Unadjusted and adjusted models showed no statistically significant relationship between inflammation and presence of any postoperative complications, number of daily stools, nighttime stooling, soiling, or stool-altering medication usage. CONCLUSION Acute histologic inflammatory activity at the rectal margin is not associated with increased rates of postoperative complications following IPAA creation in children, nor with poorer continence outcomes following ileostomy closure.
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Affiliation(s)
- Ekene Onwuka
- Nationwide Children's Hospital, Division of Pediatric Surgery, 700 Children's Dr., Columbus, OH, 43205, USA; The Ohio State University College of Medicine, Department of Surgery, 395 W. 12th Ave, Columbus, OH, 43210, USA.
| | - Justin Huntington
- Nationwide Children's Hospital, Division of Pediatric Surgery, 700 Children's Dr., Columbus, OH, 43205, USA; The Ohio State University College of Medicine, Department of Surgery, 395 W. 12th Ave, Columbus, OH, 43210, USA.
| | - Amanda Onwuka
- University of Michigan, School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Vinay Prasad
- Nationwide Children's Hospital, Division of Pathology, 700 Children's Dr, Columbus, OH, 43205, USA.
| | - Benedict Nwomeh
- Nationwide Children's Hospital, Division of Pediatric Surgery, 700 Children's Dr., Columbus, OH, 43205, USA; The Ohio State University College of Medicine, Department of Surgery, 395 W. 12th Ave, Columbus, OH, 43210, USA.
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Kevans D, Kirsch R, Dargavel C, Kabakchiev B, Riddell R, Silverberg MS. Histological Markers of Clinical Relapse in Endoscopically Quiescent Ulcerative Colitis. Inflamm Bowel Dis 2019; 26:1722-1729. [PMID: 31883337 PMCID: PMC8243631 DOI: 10.1093/ibd/izz308] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND In ulcerative colitis (UC) patients who have achieved mucosal healing, active microscopic colonic mucosal inflammation is commonly observed. We aimed to assess the association between histological activity and disease relapse in endoscopically quiescent UC. METHODS Ulcerative colitis patients with endoscopically quiescent disease and ≥12 months of follow-up were included. Biopsies were reviewed for the presence of basal plasmacytosis (BPC) and active histological inflammation, defined as a Geboes score (GS) ≥3.2. Primary outcome measures were disease relapse at 18 months and time to first relapse after index colonoscopy. RESULTS Seventy-six UC patients (51% male; mean age, 38.6 years; median follow-up [range], 75.2 [2-118] months) were included. Sixty-two percent had an endoscopic Mayo score of 0 at index colonoscopy. Basal plasmacytosis was present in 46% and active histological inflammation in 30% of subjects. Presence of BPC was associated with a significantly shorter time to disease relapse (P = 0.01). Active histological inflammation was significantly associated with clinical relapse at 18 months (P = 0.0005) and shorter time to clinical relapse (P = 0.0006). Multivariate analysis demonstrated active histological inflammation to be independently associated with clinical relapse at 18 months and time to clinical relapse. CONCLUSIONS In endoscopically quiescent UC, active histological inflammation and the presence of BPC are adjunctive histological markers associated with increased likelihood of disease relapse. Although prospective studies are required, the presence of these histological markers should be a factor considered when making therapeutic decisions in UC.
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Affiliation(s)
- David Kevans
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada,Division of Gastroenterology, Department of Medicine, Toronto, Ontario, Canada,Address correspondence to: Mark Silverberg, MD, Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Mount Sinai Hospital, 600 University Ave. Room 437, Toronto, ON M5G 1X5, Canada ()
| | - Richard Kirsch
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada,Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Callum Dargavel
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada,Division of Gastroenterology, Department of Medicine, Toronto, Ontario, Canada
| | - Boyko Kabakchiev
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Robert Riddell
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada,Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Mark S Silverberg
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada,Division of Gastroenterology, Department of Medicine, Toronto, Ontario, Canada
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Li K, Strauss R, Marano C, Greenbaum LE, Friedman JR, Peyrin-Biroulet L, Brodmerkel C, De Hertogh G. A Simplified Definition of Histologic Improvement in Ulcerative Colitis and its Association With Disease Outcomes up to 30 Weeks from Initiation of Therapy: Post Hoc Analysis of Three Clinical Trials. J Crohns Colitis 2019; 13:1025-1035. [PMID: 30721964 DOI: 10.1093/ecco-jcc/jjz022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/03/2018] [Accepted: 01/24/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Histologic evaluation is a meaningful complement to endoscopic and clinical measures in ulcerative colitis [UC]. There is a need for a definition of histologic improvement that can be used in clinical trials, and any such definition must be predictive of disease outcomes. METHODS Biopsies were collected from clinical trials (PURSUIT-SC [n = 98], JAK-UC [n = 219], and PROgECT [n = 103]) in patients with moderate-to-severe UC. A pathologist assessed biopsies in a blinded fashion using the Geboes score. A dichotomous histologic improvement end point was defined by selecting Geboes score elements according to their association strength with endoscopic healing. Fisher's exact test and Cramer's V assessed the association of histology with other measures. RESULTS Using PURSUIT-SC biopsies, histologic improvement was defined as absence of erosion or ulceration, absence of crypt destruction, and <5% of crypts with epithelial neutrophil infiltration. Histologic improvement was associated with endoscopic healing, as >90% of those with endoscopic healing in JAK-UC [Week 8] and PROgECT [Week 30] achieved histologic improvement. In JAK-UC, patients with histologic improvement had lower disease activity than patients without histologic improvement' [Mayo score = 3.8 vs 7.5] at Week 8. Week 4 histologic improvement was a strong indicator of histologic improvement, endoscopic healing, and clinical response or remission at Week 8 [all p < 0.005]. In PROgECT, 73% of patients with histologic improvement at Week 6 achieved histologic improvement at Week 30 [p = 0.0013]. CONCLUSIONS Histologic improvement based on a simplified, dichotomous Geboes score is associated with favourable endoscopic and clinical outcomes across multiple clinical studies and two therapeutic mechanisms of action.ClinicalTrials.gov number: NCT00487539 [PURSUIT-SC]; NCT01959282 [JAK-UC]; NCT01988961 [PROgECT].
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Affiliation(s)
- Katherine Li
- Janssen Research & Development, LLC, Immunology Therapeutic Area, Spring House, Pennsylvania, USA
| | - Richard Strauss
- Janssen Research & Development, LLC, Immunology Therapeutic Area, Spring House, Pennsylvania, USA
| | - Colleen Marano
- Janssen Research & Development, LLC, Immunology Therapeutic Area, Spring House, Pennsylvania, USA
| | - Linda E Greenbaum
- Janssen Research & Development, LLC, Immunology Therapeutic Area, Spring House, Pennsylvania, USA.,Novartis Institutes for Biomedical Research, East Hanover, New Jersey, USA
| | - Joshua R Friedman
- Janssen Research & Development, LLC, Immunology Therapeutic Area, Spring House, Pennsylvania, USA
| | - Laurent Peyrin-Biroulet
- INSERM Unité 954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Nancy, France
| | - Carrie Brodmerkel
- Janssen Research & Development, LLC, Immunology Therapeutic Area, Spring House, Pennsylvania, USA
| | - Gert De Hertogh
- Department of Imaging & Pathology, Translational Cell & Tissue Research, University Hospitals Leuven, Leuven, Belgium
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Fluxá D, Simian D, Flores L, Ibáñez P, Lubascher J, Figueroa C, Kronberg U, Pizarro G, Castro M, Piottante A, Vial MT, Quera R. Clinical, endoscopic and histological correlation and measures of association in ulcerative colitis. J Dig Dis 2017; 18:634-641. [PMID: 28949435 DOI: 10.1111/1751-2980.12546] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 08/30/2017] [Accepted: 09/22/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine the correlation between clinical, fecal, endoscopic and histological activity in patients with ulcerative colitis (UC). METHODS A correlational cross-sectional analysis was performed in patients with UC who underwent colonoscopy between February and December 2016. Clinical, endoscopic, fecal and histological activities were determined using the partial Mayo subscore, Mayo endoscopic subscore and modified Mayo endoscopic subscore, fecal calprotectin and Geboes score and the presence of basal plasmacytosis, respectively. Scores were analyzed using Spearman's rank correlation test. To determine the association between scores and some clinical variables and active UC, univariate and multivariate logistic regressions were used. RESULTS Altogether 105 procedures (93 patients) were included. In 64.8% of the procedures, the mucosa was inflamed; however, 14.7% did not show histological inflammation. Endoscopic remission was observed in the other 35.2% of procedures; however, in biopsies 21.6% exhibited histological inflammation. Mayo endoscopic subscore and modified Mayo endoscopic score were well correlated but were only moderately correlated with clinical and histological scores. Furthermore, there was a moderate correlation between Mayo endoscopic score and Geboes score. Conversely, histological scores were poorly correlated with partial Mayo score. In multivariate analysis, Geboes score and basal plasmacytosis were predictive of active disease (OR 3.505, 95% CI 1.544-7.959 and OR 3.240, 95% CI 1.123-9.349, respectively), whereas biological therapy was found to be protective against UC (OR 0.021, 95% CI 0.000-0.641). CONCLUSION Clinical, endoscopic and histological activities were moderately correlated, while Geboes score and basal plasmacytosis were predictive of endoscopically active UC.
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Affiliation(s)
- Daniela Fluxá
- Department of Gastroenterology, Clínica Las Condes, Santiago, Chile
| | - Daniela Simian
- Academic Department Research Unit, Clínica Las Condes, Santiago, Chile
| | - Lilian Flores
- Department of Gastroenterology, Inflammatory Bowel Disease Program, Clínica Las Condes, Santiago, Chile
| | - Patricio Ibáñez
- Department of Gastroenterology, Inflammatory Bowel Disease Program, Clínica Las Condes, Santiago, Chile
| | - Jaime Lubascher
- Department of Gastroenterology, Inflammatory Bowel Disease Program, Clínica Las Condes, Santiago, Chile
| | - Carolina Figueroa
- Department of Gastroenterology, Inflammatory Bowel Disease Program, Clínica Las Condes, Santiago, Chile
| | - Udo Kronberg
- Department of Surgery, Colorectal Surgery Unit, Inflammatory Bowel Disease Program, Clínica Las Condes, Santiago, Chile
| | - Gonzalo Pizarro
- Department of Gastroenterology, Clínica Las Condes, Santiago, Chile.,Department of Gastroenterology, Barros Luco Trudeau Hospital, Santiago, Chile
| | - Magdalena Castro
- Academic Department Research Unit, Epidemiology and Biomedical Statistics, Academic Research Unit, Clínica Las Condes, Santiago, Chile
| | | | - María T Vial
- Department of Pathology, Clínica Las Condes, Santiago, Chile
| | - Rodrigo Quera
- Department of Gastroenterology, Inflammatory Bowel Disease Program, Clínica Las Condes, Santiago, Chile
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