Correlations Between Gastrointestinal Symptoms and Endoscopic-Histologic Disease Activity in Adults with Ulcerative Colitis.

Autor: Tse CS; Division of Gastroenterology, University of Pennsylvania, 11th Floor Penn Medicine University City, 3737 Market Street, Philadelphia, PA, 19104, USA. chung.tse@pennmedicine.upenn.edu., Nguyen HP; Yale School of Medicine, New Haven, CT, USA., Singh S; Division of Gastroenterology, University of California, La Jolla, San Diego, CA, USA., Dulai PS; Division of Gastroenterology and Hepatology, Northwestern Medicine Digestive Health Center, Chicago, IL, USA., Neill J; Division of Gastroenterology, University of California, La Jolla, San Diego, CA, USA., Le H; Division of Gastroenterology, University of California, La Jolla, San Diego, CA, USA., Valasek M; Pathology Institute, 3201 University Drive East, Suite 330, Bryan, TX, 77802, USA., Dervieux T; Prometheus Laboratories, San Diego, CA, USA., Collins AE; Division of Gastroenterology, University of California, La Jolla, San Diego, CA, USA., Boland BS; Division of Gastroenterology, University of California, La Jolla, San Diego, CA, USA.
Jazyk: angličtina
Zdroj: Digestive diseases and sciences [Dig Dis Sci] 2023 Aug; Vol. 68 (8), pp. 3254-3258. Date of Electronic Publication: 2023 Jun 03.
DOI: 10.1007/s10620-023-07986-2
Abstrakt: Introduction: Discordance between gastrointestinal (GI) symptoms and endoscopic inflammation in patients with ulcerative colitis (UC) is known. However, the correlations between symptoms and endoscopic and histologic (endo-histologic) mucosal healing and remains unknown.
Methods: We performed a secondary analysis of prospectively collected clinical, endoscopic, and histologic data on 254 colonoscopies from 179 unique adults at a tertiary referral center from 2014 to 2021. Spearman's rank was used to assess the correlation between patient reported outcomes and objective assessments of disease activity, as measured by validated instruments: Two-item patient-reported outcome measure (PRO-2) for stool frequency and rectal bleeding, the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) for endoscopic inflammation, and the Geboes score for histologic inflammation. The predictive value of objective assessments of inflammation and clinical symptoms was described using sensitivity, specificity, and positive/negative predictive value.
Results: One-quarter (28%, 72/254) of cases were in endo-histologic remission; of these, 25% (18/72) report GI symptoms (22% diarrhea; 6% rectal bleeding). Endo-histologically active disease had higher sensitivity (95% rectal bleeding; 87% diarrhea) and negative predictive value (94% rectal bleeding, 78% diarrhea) for clinically active disease compared to active disease on endoscopic (77%) or histologic assessment only (80%). The specificity of endo/histologic inflammation for GI symptoms was < 65%. PRO-2 was positively correlated with endoscopic disease activity (Spearman's rank 0.57, 95% CI 0.54-0.60, p < 0.0001) and histologic disease activity (Spearman's rank 0.49, 0.45-0.53, p < 0.0001).
Conclusion: One-quarter of patients with ulcerative colitis in endo-histologic (deep) remission have gastrointestinal symptoms, more commonly with diarrhea than rectal bleeding. Endo-histologic inflammation has high sensitivity (≥ 87%) for diarrhea/rectal bleeding.
(© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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