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 17 February 2018

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News

Predictor of clinical relapse among patients with ulcerative colitis

This month's issue of the American Journal of Gastroenterology explores histological disease activity as a predictor of clinical relapse among patients with ulcerative colitis.

News image

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Endoscopic remission in ulcerative colitis (UC) is associated with improved clinical outcomes. 

Dr Loren Laine and colleagues from Connecticut, USA assessed whether histological remission predicts clinical outcomes, estimated the magnitude of effect, and determined whether histological remission provides additional prognostic utility beyond clinical or endoscopic remission.

Bibliographic databases were searched for studies in inflammatory bowel disease providing baseline histological status and relation to an outcome of clinical relapse or exacerbation. 

The research team's primary analysis compared the proportion of patients with study-defined histological remission vs. the proportion with histological activity who developed clinical relapse/exacerbation. 

The team used additional analyses to compare the proportion with relapse/exacerbation for the presence vs. absence of different histological features and for histological remission vs. endoscopic remission and clinical remission. 

The team identified 15 studies that met inclusion criteria. 

The major methodological shortcoming was lack of blinding of the assessor of clinical relapse/exacerbation to baseline histological status in 13 of the 15 studies. 

The researchers found that relapse/exacerbation was less frequent with baseline histological remission vs. histological activity, and vs. baseline clinical and endoscopic remission. 

Relapse/exacerbation was also less common in the absence vs. presence of specific histological features: neutrophils in epithelium, neutrophils in lamina propria, crypt abscesses, eosinophils in the lamina propria, and chronic inflammatory cell infiltrate. 

The research team observed that histological remission was present in 71% of the 1360 patients with combined endoscopic and clinical remission at baseline.

Dr Laine's team comments, "UC patients with histological remission have a significant 52% relative risk reduction in clinical relapse/exacerbation compared with those with histological activity."

"Histological remission is also superior to endoscopic and clinical remission in predicting clinical outcomes."

"As about 30% of patients with endoscopic and clinical remission still have histological activity, addition of histological status as an end point in clinical trials or practice has the potential to improve clinical outcomes."
,
Endoscopic remission in ulcerative colitis (UC) is associated with improved clinical outcomes. 

Dr Loren Laine and colleagues from Connecticut, USA assessed whether histological remission predicts clinical outcomes, estimated the magnitude of effect, and determined whether histological remission provides additional prognostic utility beyond clinical or endoscopic remission.

Bibliographic databases were searched for studies in inflammatory bowel disease providing baseline histological status and relation to an outcome of clinical relapse or exacerbation. 

The research team's primary analysis compared the proportion of patients with study-defined histological remission vs. the proportion with histological activity who developed clinical relapse/exacerbation. 

The team used additional analyses to compare the proportion with relapse/exacerbation for the presence vs. absence of different histological features and for histological remission vs. endoscopic remission and clinical remission. 

The team identified 15 studies that met inclusion criteria. 

The major methodological shortcoming was lack of blinding of the assessor of clinical relapse/exacerbation to baseline histological status in 13 of the 15 studies. 

The researchers found that relapse/exacerbation was less frequent with baseline histological remission vs. histological activity, and vs. baseline clinical and endoscopic remission. 

Relapse/exacerbation was also less common in the absence vs. presence of specific histological features: neutrophils in epithelium, neutrophils in lamina propria, crypt abscesses, eosinophils in the lamina propria, and chronic inflammatory cell infiltrate. 

The research team observed that histological remission was present in 71% of the 1360 patients with combined endoscopic and clinical remission at baseline.

Dr Laine's team comments, "UC patients with histological remission have a significant 52% relative risk reduction in clinical relapse/exacerbation compared with those with histological activity."

"Histological remission is also superior to endoscopic and clinical remission in predicting clinical outcomes."

"As about 30% of patients with endoscopic and clinical remission still have histological activity, addition of histological status as an end point in clinical trials or practice has the potential to improve clinical outcomes."
,
Endoscopic remission in ulcerative colitis (UC) is associated with improved clinical outcomes. 

Dr Loren Laine and colleagues from Connecticut, USA assessed whether histological remission predicts clinical outcomes, estimated the magnitude of effect, and determined whether histological remission provides additional prognostic utility beyond clinical or endoscopic remission.

Bibliographic databases were searched for studies in inflammatory bowel disease providing baseline histological status and relation to an outcome of clinical relapse or exacerbation. 

The research team's primary analysis compared the proportion of patients with study-defined histological remission vs. the proportion with histological activity who developed clinical relapse/exacerbation. 

The team used additional analyses to compare the proportion with relapse/exacerbation for the presence vs. absence of different histological features and for histological remission vs. endoscopic remission and clinical remission. 

The team identified 15 studies that met inclusion criteria. 

The major methodological shortcoming was lack of blinding of the assessor of clinical relapse/exacerbation to baseline histological status in 13 of the 15 studies. 

The researchers found that relapse/exacerbation was less frequent with baseline histological remission vs. histological activity, and vs. baseline clinical and endoscopic remission. 

Relapse/exacerbation was also less common in the absence vs. presence of specific histological features: neutrophils in epithelium, neutrophils in lamina propria, crypt abscesses, eosinophils in the lamina propria, and chronic inflammatory cell infiltrate. 

The research team observed that histological remission was present in 71% of the 1360 patients with combined endoscopic and clinical remission at baseline.

Dr Laine's team comments, "UC patients with histological remission have a significant 52% relative risk reduction in clinical relapse/exacerbation compared with those with histological activity."

"Histological remission is also superior to endoscopic and clinical remission in predicting clinical outcomes."

"As about 30% of patients with endoscopic and clinical remission still have histological activity, addition of histological status as an end point in clinical trials or practice has the potential to improve clinical outcomes."

Am J Gastroenterol 2016; 111:1692–1701
13 December 2016

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