Beyond endoscopic mucosal healing in UC: histological remission better predicts corticosteroid use and hospitalisation over 6â
years of follow-up.
Gut
; 65(3): 408-14, 2016 Mar.
Article
em En
| MEDLINE
| ID: mdl-25986946
ABSTRACT
BACKGROUND:
Endoscopic mucosal healing is an established treatment target for UC, yet the value of achieving histological remission remains unclear.AIMS:
To evaluate histological remission compared to endoscopic mucosal healing for predicting patient outcomes in UC.METHODS:
Blinded assessment of endoscopic and histological measures of disease activity was performed on patients with established UC at baseline. Concordance and prognostic values of endoscopic mucosal healing (defined by Baron score ≤1) and histological remission (defined by Truelove and Richards' index) for predicting outcomes of corticosteroid use, hospitalisation and colectomy were determined over a median 6â years follow-up, including κ statistics and Cox regression multivariate analysis.RESULTS:
91 patients with UC were followed up for a median 72â months (IQR 54-75â months). Overall, concordance between endoscopic and histological remission was moderate (κ=0.56, 95% CI 0.36 to 0.77); 24% patients had persistent inflammation despite endoscopic remission. Histological remission predicted corticosteroid use and acute severe colitis requiring hospitalisation over the follow-up period (HR 0.42 (0.2 to 0.9), p=0.02; HR 0.21 (0.1 to 0.7), p=0.02; respectively), whereas endoscopic mucosal healing did not (HR 0.86, 95% CI 0.5 to 1.7, p0.65; HR 0.83 95% CI 0.3 to 2.4, p0.74; respectively).CONCLUSIONS:
Histological remission is a target distinct from endoscopic mucosal healing in UC and better predicts lower rates of corticosteroid use and acute severe colitis requiring hospitalisation, over a median of 6â years of follow-up. Our findings support the inclusion of histological indices in both UC clinical trials and practice, towards a target of 'complete remission'.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Colite Ulcerativa
/
Colonoscopia
/
Corticosteroides
/
Colo
/
Hospitalização
/
Mucosa Intestinal
/
Anti-Inflamatórios
Tipo de estudo:
Clinical_trials
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Gut
Ano de publicação:
2016
Tipo de documento:
Article
País de afiliação:
Reino Unido