Histological Inflammation in the Endoscopically Uninflamed Mucosa is Associated With Worse Outcomes in Limited Ulcerative Colitis.

Autor:	de Frias Gomes CG; Gastroenterology Division, Hospital Beatriz Ângelo, Loures, Portugal., de Almeida ASR; Faculdade de Ciências e Centro de Estatística e Aplicações da Universidade de Lisboa, Lisboa, Portugal., Mendes CCL; Hospital CUF Descobertas, Lisbon, Portugal., Ellul P; Mater Dei Hospital, Msida, Malta., Burisch J; Gastrounit, Medical Division, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark., Buhagiar T; Mater Dei Hospital, Msida, Malta., Attard A; Mater Dei Hospital, Msida, Malta., Lo B; Gastrounit, Medical Division, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark., Ungaro RC; The Dr. Henry Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA., da Silva Morão BT; Gastroenterology Division, Hospital Beatriz Ângelo, Loures, Portugal., Gouveia CF; Gastroenterology Division, Hospital Beatriz Ângelo, Loures, Portugal., de Carvalho E Branco JMD; Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal., Rodrigues JMMP; Gastroenterology Division, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal., Teixeira C; Gastroenterology Division, Centro Hospitalar de Setúbal, Setúbal, Portugal., Dias de Castro MFF; Gastroenterology Division, Hospital da Senhora da Oliveira, Guimarães, Portugal., Nunes GFD; Gastroenterology Division, Hospital Garcia de Orta, Almada, Portugal., Brito M; Gastroenterology Division, Hospital Garcia de Orta, Almada, Portugal., de Sousa Antunes MC; Faculdade de Ciências e Centro de Estatística e Aplicações da Universidade de Lisboa, Lisboa, Portugal., Borralho Nunes PMFB; Hospital CUF Descobertas, Lisbon, Portugal.; Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal., da Silva Torres JMT; Gastroenterology Division, Hospital Beatriz Ângelo, Loures, Portugal.
Jazyk:	angličtina
Zdroj:	Inflammatory bowel diseases [Inflamm Bowel Dis] 2022 Mar 02; Vol. 28 (3), pp. 350-357.
DOI:	10.1093/ibd/izab069
Abstrakt:	Background: The Montreal classification categorizes patients with ulcerative colitis (UC) based on their macroscopic disease extent. Independent of endoscopic extent, biopsies through all colonic segments should be retrieved during index colonoscopy. However, the prognostic value of histological inflammation at diagnosis in the inflamed and uninflamed regions of the colon has never been assessed. Methods: This was a multicenter retrospective cohort study of newly diagnosed patients with treatment-naïve proctitis and left-sided UC. Biopsies from at least 2 colonic segments (endoscopically inflamed and uninflamed mucosa) were retrieved and reviewed by 2 pathologists. Histological features in the endoscopically inflamed and uninflamed mucosa were scored using the Nancy score. The primary outcomes were disease complications (proximal disease extension, need for hospitalization or colectomy) and higher therapeutic requirements (need for steroids or for therapy escalation). Results: Overall, 93 treatment-naïve patients were included, with a median follow-up of 44 months (range, 2-329). The prevalence of any histological inflammation above the endoscopic margin was 71%. Proximal disease extension was more frequent in patients with histological inflammation in the endoscopically uninflamed mucosa at diagnosis (21.5% vs 3.4%, P = 0.04). Histological involvement above the endoscopic margin was the only predictor associated with an earlier need for therapy escalation (adjusted hazard ratio, 3.69; 95% confidence interval, 1.05-13.0); P = 0.04) and disease complications (adjusted hazard ratio, 4.79; 95% confidence interval, 1.10-20.9; P = 0.04). Conclusions: The presence of histological inflammation in the endoscopically uninflamed mucosa at the time of diagnosis was associated with worse outcomes in limited UC. (© 2021 Crohn’s & Colitis Foundation. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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