title: Beyond endoscopic mucosal healing in UC: histological remission better predicts corticosteroid use and hospitalisation over 6 years of follow-up.
abstract: BACKGROUND
  Endoscopic mucosal healing is an established treatment target for UC, yet the value of achieving histological remission remains unclear.
  
  
  OBJECTIVE
  To evaluate histological remission compared to endoscopic mucosal healing for predicting patient outcomes in UC.
  
  
  METHODS
  Blinded assessment of endoscopic and histological measures of disease activity was performed on patients with established UC at baseline. Concordance and prognostic values of endoscopic mucosal healing (defined by Baron score ≤1) and histological remission (defined by Truelove and Richards' index) for predicting outcomes of corticosteroid use, hospitalisation and colectomy were determined over a median 6 years follow-up, including κ statistics and Cox regression multivariate analysis.
  
  
  RESULTS
  91 patients with UC were followed up for a median 72 months (IQR 54-75 months). Overall, concordance between endoscopic and histological remission was moderate (κ=0.56, 95% CI 0.36 to 0.77); 24% patients had persistent inflammation despite endoscopic remission. Histological remission predicted corticosteroid use and acute severe colitis requiring hospitalisation over the follow-up period (HR 0.42 (0.2 to 0.9), p=0.02; HR 0.21 (0.1 to 0.7), p=0.02; respectively), whereas endoscopic mucosal healing did not (HR 0.86, 95% CI 0.5 to 1.7, p0.65; HR 0.83 95% CI 0.3 to 2.4, p0.74; respectively).
  
  
  CONCLUSIONS
  Histological remission is a target distinct from endoscopic mucosal healing in UC and better predicts lower rates of corticosteroid use and acute severe colitis requiring hospitalisation, over a median of 6 years of follow-up. Our findings support the inclusion of histological indices in both UC clinical trials and practice, towards a target of 'complete remission'.
authors.affiliation: Translational Gastroenterology Unit and Department of Cellular Pathology, John Radcliffe Hospital, Oxford, UK.
authors.forename: Robert V
authors.initials: RV
authors.lastname: Bryant
authors.affiliation: Translational Gastroenterology Unit and Department of Cellular Pathology, John Radcliffe Hospital, Oxford, UK.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Burger
authors.affiliation: Translational Gastroenterology Unit and Department of Cellular Pathology, John Radcliffe Hospital, Oxford, UK.
authors.forename: Joseph
authors.initials: J
authors.lastname: Delo
authors.affiliation: Translational Gastroenterology Unit and Department of Cellular Pathology, John Radcliffe Hospital, Oxford, UK.
authors.forename: Alissa J
authors.initials: AJ
authors.lastname: Walsh
authors.affiliation: Translational Gastroenterology Unit and Department of Cellular Pathology, John Radcliffe Hospital, Oxford, UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Thomas
authors.affiliation: Translational Gastroenterology Unit and Department of Cellular Pathology, John Radcliffe Hospital, Oxford, UK.
authors.forename: Axel
authors.initials: A
authors.lastname: von Herbay
authors.affiliation: Translational Gastroenterology Unit and Department of Cellular Pathology, John Radcliffe Hospital, Oxford, UK.
authors.forename: Otto C
authors.initials: OC
authors.lastname: Buchel
authors.affiliation: Translational Gastroenterology Unit and Department of Cellular Pathology, John Radcliffe Hospital, Oxford, UK.
authors.forename: Lydia
authors.initials: L
authors.lastname: White
authors.affiliation: Translational Gastroenterology Unit and Department of Cellular Pathology, John Radcliffe Hospital, Oxford, UK.
authors.forename: Oliver
authors.initials: O
authors.lastname: Brain
authors.affiliation: Translational Gastroenterology Unit and Department of Cellular Pathology, John Radcliffe Hospital, Oxford, UK.
authors.forename: Satish
authors.initials: S
authors.lastname: Keshav
authors.affiliation: Translational Gastroenterology Unit and Department of Cellular Pathology, John Radcliffe Hospital, Oxford, UK.
authors.forename: Bryan F
authors.initials: BF
authors.lastname: Warren
authors.affiliation: Translational Gastroenterology Unit and Department of Cellular Pathology, John Radcliffe Hospital, Oxford, UK.
authors.forename: Simon P L
authors.initials: SP
authors.lastname: Travis
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D003082:Colectomy / Q000706:statistics & numerical data; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D003106:Colon / Q000473:pathology* / Q000601:surgery; D003113:Colonoscopy; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012074:Remission Induction; D012720:Severity of Illness Index; D016037:Single-Blind Method; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents
keywords: HISTOPATHOLOGY; INFLAMMATORY BOWEL DISEASE; MUCOSAL REPAIR; ULCERATIVE COLITIS