title: Prognostic value of serologic and histologic markers on clinical relapse in ulcerative colitis patients with mucosal healing.
abstract: OBJECTIVE
  Endoscopic mucosal healing is a key endpoint for the treatment of ulcerative colitis (UC). The role of microscopic activity in predicting disease relapse has not been fully assessed. We aimed to investigate the predictive role of serologic and histologic markers on disease relapse in UC patients with endoscopically inactive disease.
  
  
  METHODS
  Adult UC patients with endoscopically inactive disease (Mayo 0) and a 12-month follow-up between 2008 and 2011 were retrospectively included. An expert pathologist evaluated all colonic biopsies for histologic activity (Geboes score) and the presence of basal plasmacytosis. Blood samples collected around the time of endoscopy were analyzed. Disease relapse, defined as a clinical Mayo score ≥3, was documented during follow-up.
  
  
  RESULTS
  The study cohort consisted of 75 patients (53% men, median age 47 years). Despite normal endoscopy, histology showed inflammatory activity with a Geboes score ≥3.1 in 40% and basal plasmacytosis in 21% of patients. At 12 months, clinical relapse was observed in 20% (n=15) of patients. Presence of basal plasmacytosis (P=0.007) and a Geboes score ≥3.1 (P=0.007) were predictive of disease relapse. Using multivariate analysis, the presence of basal plasmacytosis was predictive of clinical relapse (odds ratio (OR) 5.13 (95% confidence interval (CI): 1.32-19.99), P=0.019), whereas the use of biologicals at endoscopy favored remission (OR 0.24 (95% CI: 0.05-1.01), P=0.052).
  
  
  CONCLUSIONS
  We demonstrated that the presence of basal plasmacytosis predicts UC clinical relapse in patients with complete mucosal healing. We recommend closer follow-up and optimization of medical therapy in patients with basal plasmacytosis.
authors.affiliation: Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium. talat.bessissow@mcgill.ca
authors.forename: Talat
authors.initials: T
authors.lastname: Bessissow
authors.forename: Bart
authors.initials: B
authors.lastname: Lemmens
authors.forename: Marc
authors.initials: M
authors.lastname: Ferrante
authors.forename: Raf
authors.initials: R
authors.lastname: Bisschops
authors.forename: Kristel
authors.initials: K
authors.lastname: Van Steen
authors.forename: Karel
authors.initials: K
authors.lastname: Geboes
authors.forename: Gert
authors.initials: G
authors.lastname: Van Assche
authors.forename: Séverine
authors.initials: S
authors.lastname: Vermeire
authors.forename: Paul
authors.initials: P
authors.lastname: Rutgeerts
authors.forename: Gert
authors.initials: G
authors.lastname: De Hertogh
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000032:analysis*; D001706:Biopsy; D016009:Chi-Square Distribution; D003093:Colitis, Ulcerative / Q000473:pathology*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D018709:Statistics, Nonparametric
chemical_list: D015415:Biomarkers