Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Department of Gastroenterology, Nancy University Hospital, Vandoeuvre-les-Nancy, France; French Institute of Health and Medical Research U1256 NGERE, University of Lorraine, Vandoeuvre-les-Nancy, France.
Clin Gastroenterol Hepatol. 2021 Sep;19(9):1800-1813.e4. doi: 10.1016/j.cgh.2020.09.046. Epub 2020 Sep 30.
Endoscopic remission is a recognized therapeutic endpoint in inflammatory bowel disease (IBD; Crohn's disease (CD), ulcerative colitis (UC)). The impact of persistent histologic activity on long-term outcomes is less clear and limited by small studies.
We performed a systematic search of PubMed and Embase to identify eligible studies examining the association between histologic activity and relapse in patients with CD or UC in endoscopic remission. Studies were pooled together using random effects meta-analysis per the DerSimonian and Laird inverse variance method. The impact of different histologic scales, cut-offs, and individual features were examined.
Our meta-analysis included 28 studies contributing 2,806 patients (2677 UC; 129 CD). In UC, histologically active disease was associated with an overall increased risk of relapse (OR, 2.41; 95% CI, 1.91-3.04), with a similar effect noted in the subgroup with endoscopic Mayo endoscopic score of 0 vs 0 or 1. More rigorous Geboes cut-offs demonstrated numerically stronger impact on relapse rates-Geboes <3.1 (OR, 2.40; 95% CI, 1.57-3.65), Geboes <2.1 (OR, 3.91; 95% CI, 2.21-6.91) and Geboes 0 (OR, 7.40; 95% CI, 2.00-18.27). Among individual histologic features, basal plasmacytosis (OR, 1.94), neutrophilic infiltrations (OR, 2.30), mucin depletion (OR, 2.05), and crypt architectural irregularities (OR, 2.22) predicted relapse. There was no association between histologic activity and relapse in CD.
In patients with UC in endoscopic remission, persistent histologic activity is associated with higher rates of relapse. Greater degree of normalization may have a stronger impact.
内镜缓解是炎症性肠病（IBD；克罗恩病（CD），溃疡性结肠炎（UC））的公认治疗终点。持续性组织学活动对长期结局的影响尚不清楚，并且受到小型研究的限制。
我们对 PubMed 和 Embase 进行了系统搜索，以确定检查内镜缓解的 CD 或 UC 患者组织学活动与复发之间关联的合格研究。使用 DerSimonian 和 Laird 逆方差法的随机效应荟萃分析将研究合并在一起。检查了不同组织学量表、截止值和个体特征的影响。
我们的荟萃分析包括 28 项研究，涉及 2806 名患者（2677 名 UC；129 名 CD）。在 UC 中，组织学上活跃的疾病与总体复发风险增加相关（OR，2.41；95%CI，1.91-3.04），在内镜 Mayo 内镜评分 0 与 0 或 1 的亚组中也观察到了类似的效果。更严格的 Geboes 截止值显示出对复发率的数值更强的影响-Geboes <3.1（OR，2.40；95%CI，1.57-3.65），Geboes <2.1（OR，3.91；95%CI，2.21-6.91）和 Geboes 0（OR，7.40；95%CI，2.00-18.27）。在个别组织学特征中，基底浆细胞增多（OR，1.94），中性粒细胞浸润（OR，2.30），粘蛋白耗竭（OR，2.05）和隐窝结构不规则（OR，2.22）预测复发。组织学活动与 CD 中的复发之间没有关联。
在内镜缓解的 UC 患者中，持续性组织学活动与更高的复发率相关。更大程度的正常化可能具有更强的影响。
