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P124. Mucosal healing in ulcerative colitis: No relation between histology and clinical findings


A.A. Nunes1, A.I. Vieira1, T. Meira1, R. Ilgenfritz2, P. Borralho-Nunes2, J. Freitas1

1Hospital Garcia De Orta, Department of Gastroenterology, Almada, Portugal; 2Hospital Garcia De Orta, Department of Pathology, Almada, Portugal



Background: Clinical remission and endoscopic mucosal healing are important endpoints in management of Ulcerative Colitis (UC); however, even in asymptomatic patients with healed mucosa, a variety of histological patterns can be found in the large bowel mucosa (Truelove 1956, Riley 1991). Our aim was to evaluate the histological patterns in quiescent UC in order to identify the prevalence of signs of persistent activity and chronic inflammation in healed mucosa, and to relate these findings to clinical data, including therapy.

Methods: From UC patients attending an outpatient IBD clinic we selected a series of 30 consecutive UC patients with no pain, no rectal bleeding and no more than two bowel movements/day in the preceding 6 months. Patients using topical therapy were not included. Patients were excluded if endoscopic evaluation showed blood, ulcers, erosions, friability, or focal erythema in >25% of the mucosa. Rectal biopsies were evaluated by two independent pathologists and inflammatory changes were scored according to chronicity (distortion, atrophy, Paneth cell metaplasia, chronic inflammation, eosinophils) or activity (superficial erosions, mucus depletion, acute inflammation). Biopsies of normal mucosa from patients without colonic disease were used as controls. Histological findings were correlated with clinical data (duration of the disease, colonic extension, anaemia) and with the type of treatment; statistical analysis tests: Mann-Whitney, chi-square and Spearman for non-parametric data.

Results: Thirty patients, 29 treated with 5‑ASA, 8 with immunosuppressants, 4 with infliximab and 12 with present or past corticosteroid use. Histological profile confirmed clear histological difference between patients and controls (p = 0.000). Patients: Two groups, according to chronicity and activity scores: Group 1: 4 patients with no difference from controls (score ≤2); Group 2: 26 patients different from normal with scores >2. No correlation was found between duration of the disease, colonic extension and presence of anaemia, with the histological score. No significant correlation was found between score and therapy.

Conclusions: Healed mucosa in quiescent colitis may show important signs of persistent activity and chronic inflammation, but these are not correlated with extension and duration of disease, and neither with past or present anaemia. Therapy did not influence histological score.