From the Journals

Rethinking histology as treatment target in ulcerative colitis


No impact of histology on relapse risk

Further analysis revealed that there was no association between clinical relapse and age, sex, disease extent, and C-reactive protein, hemoglobin, and albumin levels. However, there was a significant association between relapse and the occurrence of at least one relapse in the 2 years prior to enrollment.

While the mean baseline fecal calprotectin (FC) level was numerically higher in patients who experienced relapse, compared with those who did not (306.9 mcg/g vs. 213.7 mcg/g), the difference was not significant.

FC of greater than 100 mcg/g was, however, significantly associated with relapse, at an odds ratio of 2.26, although the association was no longer significant when using the False Discovery Rate test.

Active histology was no more common among those who experienced relapse than among those who did not. But with regard to histologic factors, the team found that the presence of basal plasmacytosis was associated with clinical relapse, at an adjusted odds ratio of 2.07.

On the other hand, a Geboes Score of greater than or equal to 3.1, indicating the presence of epithelial neutrophils with or without crypt destruction or erosions, was not significantly associated with the risk of relapse, nor with the time to clinical relapse.

Clinical implications

Approached for comment, Miguel Regueiro, MD, chair of the Digestive Disease and Surgery Institute at the Cleveland Clinic, said that this is “the largest prospective study assessing histologic activity or remission to predict future disease relapse in ulcerative colitis.”

He told this news organization that what the findings mean for clinical practice is that “patients who achieve an endoscopic and clinical remission are at a low likelihood of clinical relapse,” and added that “these should be the ‘treat-to-target’ endpoints.”

“Patients who have biopsy evidence, [such as] histologic activity based on the Geboes Score, do not require an escalation of therapy or a change in inflammatory bowel disease therapy,” Dr. Regueiro said.

He noted, however, that one primary question remains: Aside from surveillance of dysplasia, is there a role for biopsy in cases of UC in which the Mayo score is 0?

“In my practice, I still take biopsies from a previously involved colitis segment, even if Mayo 0,” he said.

“If there is histologic activity, I would not increase or optimize the current medications, but I also would not deescalate,” Dr. Regueiro added. “I would keep the patient on a regular surveillance colonoscopy regimen, too.”

No funding for the study has been reported. Dr. Bessissow has relationships with AbbVie, Alimentiv (formerly Robarts), Amgen, Bristol-Myers-Squibb, Ferring, Gilead, Janssen, Merck, Pentax, Pfizer, Roche, Sandoz, Takeda, and Viatris. Other authors have disclosed numerous financial relationships. Dr. Regueiro has disclosed no such relationships.

A version of this article first appeared on


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