Complete Resolution of Mucosal Neutrophils Associates With Improved Long-Term Clinical Outcomes of Patients With Ulcerative Colitis

Rish K Pai; Douglas J Hartman; Claudia Ramos Rivers; Miguel Regueiro; Marc Schwartz; David G Binion; Reetesh K Pai

doi:10.1016/j.cgh.2019.12.011

Complete Resolution of Mucosal Neutrophils Associates With Improved Long-Term Clinical Outcomes of Patients With Ulcerative Colitis

Clin Gastroenterol Hepatol. 2020 Oct;18(11):2510-2517.e5. doi: 10.1016/j.cgh.2019.12.011. Epub 2019 Dec 14.

Authors

Rish K Pai¹, Douglas J Hartman², Claudia Ramos Rivers³, Miguel Regueiro⁴, Marc Schwartz³, David G Binion³, Reetesh K Pai⁵

Affiliations

¹ Department of Pathology and Laboratory Medicine, Mayo Clinic Arizona, Scottsdale, Arizona.
² Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
³ Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
⁴ Division of Gastroenterology, Cleveland Clinic, Cleveland, Ohio.
⁵ Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Electronic address: pair@upmc.edu.

PMID: 31843598
DOI: 10.1016/j.cgh.2019.12.011

Abstract

Background & aims: We investigated correlations between histologic features of the colonic mucosa in patients with ulcerative colitis (UC) and clinical outcomes during a 3-year follow-up period.

Methods: We obtained baseline biopsies from all colorectal segments (n = 889) from 281 patients with UC enrolled in a prospective study at a single center from 2009 through 2013. Biopsies were assessed in a blinded manner using validated histologic scoring systems (the Geboes score, Nancy histopathologic index, and Robarts histopathologic index). Clinical, endoscopic, and histologic data were collected and tested for correlations with systemic corticosteroid use, hospitalization, and colectomy within 3 years of the index colonoscopy.

Results: We found histologic evidence of UC activity (Geboes score ≥ 2B.1) in biopsies from 182 patients (65%) and endoscopic evidence of UC activity in 149 patients (53%) (substantial agreement, κ = 0.60). Histologic features of UC activity were associated with increased rates of systemic corticosteroid use, colectomy, and hospitalization in the entire cohort (P < .05 for all) and associated with increased rates of systemic corticosteroid use in an analysis limited to patients in endoscopic remission (P < .001). In patients in endoscopic remission, only histologic activity was independently associated with use of systemic corticosteroids (multivariate odds ratio, 6.34; 95% CI, 2.20-18.28; P = .001). Similar results were seen when the entire cohort was analyzed. Compared with patients without histologic evidence of UC activity, patients with only a small number of mucosal neutrophils still had higher rates of systemic corticosteroid use (P < .001).

Conclusions: Histologic evidence of UC activity, including small numbers of neutrophils in the colonic mucosa, is the only factor independently associated with use of systemic corticosteroids. Complete resolution of neutrophil-associated inflammation should be a target for treatment of UC.

Keywords: Immune Cell; Inflammatory Bowel Diseases; Prognostic Factor; Therapy.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Colitis, Ulcerative* / drug therapy
Colonoscopy
Humans
Intestinal Mucosa
Neutrophils*
Prospective Studies
Severity of Illness Index