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P144 Correlation between clinical, endoscopic, histological activity scores in a cohort of patients with ulcerative colitis: a prospective study

B. Neri*1, S. Romeo1, F. Zorzi1, E. De Cristofaro1, E. Calabrese1, E. Grasso1, G. Palmieri2, L. Biancone1

1University of Rome 'Tor Vergata', Gastroenterology, Rome, Italy, 2University or Rome 'Tor Vergata', Anatomopathology, Rome, Italy

Background

The relationship between clinical, endoscopic and histological scores used in ulcerative colitis (UC) is debated. Primary aim was to assess, in a prospective study, the correlation between clinical, endoscopic, and histological scores of activity in a cohort of UC patients undergoing colonoscopy. Secondary aim was to assess the role of histological scores in clinical practice.

Methods

From February 2016 to February 2017 UC patients undergoing colonoscopy according to clinical indication were enrolled. Inclusion criteria: (1) diagnosis of IBD; (2) age> 18, <80 years; (3) regular follow-up; (4) indication for colonoscopy. During colonoscopy ≥2 biopsies were taken from ≥1 macroscopically involved area and, possibly, from ≥1 uninvolved area. All colonoscopies were performed by the same IBD-dedicated gastroenterologist. Clinical activity was assessed with Mayo partial score (activity ≥3),1 endoscopic activity with the Mayo endoscopic score (activity ≥2).1 Histological activity was assessed by the same IBD-dedicated pathologist using the Geboes Simplified Score for UC (activity ≥3.1).2 Scores were blindly assessed. Follow-up was planned at 1 year. Data expressed as median [range]; coefficient of correlation; T-test.

Results

UC cohort included 91 patients (M 52 [57%], age 51 [24–80] years, UC duration 15 years [1–48] years). UC extent was n (%): pancolitis 43(47%), left sided 25(28%), proctitis 22(25%) patients. The day of colonoscopy UC was clinically active in 16 (18%), inactive in 75 (82%) patients. Endoscopic activity was observed in 46(51%) patients (Mayo score: [n]: 0[17];1[28]; 2[21], 3[25]). In UC, microscopic activity (GSS ≥ 3.1) was observed in 39/91 (43%) patients: 5 of these 39 patients were in endoscopic remission. Significant correlation was observed between clinical vs. endoscopic scores (r = 0.486; p < 0.0001); clinical vs. histological scores (r = 0.35; p < 0.0001). At 1-year clinical follow-up data were available in 77 UC patients (75%). In 1 year, UC has been clinically active in 24 (31%) patients, inactive in 53 (69%) patients. 11/24 (46%) patients were clinically active at baseline, 15/24 (63%) patients endoscopically and 16/24 (67%) patients histologically. Of the 5 patients in endoscopic remission and histological activity at baseline, 1 had a clinical relapse.

Conclusion

In a prospective study, significant correlation was observed between clinical, endoscopic and histological activity in UC. Histological activity observed in UC patients in endoscopic remission may represent a predictive marker of clinical relapse.

Correlation between clinical and endoscopic, endoscopic and histological, clinical and histological activity scores

References

1. Schroeder KW, Tremaine WJ, Ilstrup DM. Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. N Engl J Med 1987;317:1625–9.

2. Jauregui-Amezaga A, Geerits A, Das Y et al. A simplified Geboes score for ulcerative colitis. J Crohns Colitis 2017;11:305–313.