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P274 The association between the severity of histological lesions with the disease location and presence of colonic lesions in patients with ulcerative colitis

A. Abou Rached*1, J. Saniour1, R. Shehab3, C. Abou Fadel4, C. Yaghi5, S. Khairallah3

1Lebanese University, Faculty of Medical Sciences, Gastroenterology, Hadath, Lebanon, 3Lebanese University, Faculty of Medical Sciences, Pathology, Hadath, Lebanon, 4Sacre Coeur Hospital, Gastroenterology, Hadath, Lebanon, 5Saint Joseph University, Gastroenterology, Beirut, Lebanon

Background

Multiple histological scores evaluate the disease activity UC including GEBOES, GUPTA, Gramlich, amongst others. The objective of this study was to assess the severity of histological lesions in patients with UC using these three scores and to check if there is an association with disease location, presence of polyps, dysplasia and cancer

Methods

This is a retrospective study whereby all UC pathology reports, in the biggest pathology centre in Beirut between 2006 and 2016, were reviewed and subjected to a second reading. Several variables were analysed: age, sex, extent of lesions, and presence of polyps, dysplasia and cancer. GEBEOS, GUPTA, and Gramlich scores were used to evaluate the severity of the histological lesions.

Results

In total, 1096 patients were diagnosed with UC during the period ranging from 2006 to 2016. Mean age was 42 years and 48.9% were females. Sixty-one per cent of patients had their first disease flare, 26.6% had a relapse and 9.9% had the disease controlled on treatment. For disease location, pancolitis was present in 53% of patients, left sided colitis in 20.2% and proctitis in 26.8% of patients. Hyperplastic polyps were present in 1% of patients with a mean age of 45 years, adenomas in 2.6% with mean age of 56 years and inflammatory pseudopolyps in 6.1% with a mean age of 47 years. There was no difference between the sexes. The majority of inflammatory polyps arised in patients with pancolitis with significant difference when compared with the two other locations. There was no difference in the presence of hyperplastic polyps and adenomas in regards to the different disease locations. In patients with adenomas, low-grade dysplasia was noted in 82.8%, high-grade dysplasia in 10.3% and cancer in 6.9%, whereas 1.6% of patients with inflammatory pseudopolyps had dysplasia. The presence of dysplasia and cancer was 0.8% and 0.9%, respectively, with a mean age of 63 years for patients with dysplasia and 56 years for patients with cancer. Regarding histological severity, 2%, 74.5%, 20.2% 2%, 8% and 1.1% were graded as 5, 4, 3, 2, 1 and 0, respectively, using the GEBOES score. 74.7%, 8.8% et 11.8% and 2.1% had Gramlich scores of 3, 2, 1 and 0, respectively and finally 74.7%, 8.6%, 12% and 2.% had a GUPTA score of 3, 2, 1, and 0, respectively, Lesions’ severity was not linked to the disease location but the presence of adenomas, inflammatory pseudopolyps and hyperplastic polyps was significantly higher in patients with elevated histological scores.

Conclusion

The majority (>75%) of UC patients had severe lesions according to the different scores (GEBOES, Gramlich, and GUPTA). Histological severity was not linked to disease location, but was associated with a higher prevalence of inflammatory pseudopolyps, adenomas and dysplasia.