Division of Gastroenterology, Department of Internal Medicine, Mubarak Alkaber Hospital, Kuwait City, Kuwait.
Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Kuwait City, Kuwait.
Inflamm Bowel Dis. 2024 Apr 3;30(4):563-572. doi: 10.1093/ibd/izad119.
The clinical impact of histological remission on short- and long-term clinical outcomes in patients with inflammatory bowel disease (IBD) is not well established. We assessed risk of clinical relapse, hospitalization, and need for surgery in patients achieving histological remission in comparison with active histological disease.
A systematic review was conducted using MEDLINE, Scopus, Cochrane CENTRAL, EMBASE, and conference abstracts from inception to November 2022. Our main outcome was the rate of clinical relapse in patients with IBD who reached histological remission vs patients with active histological disease. Secondary outcomes were clinical complications of IBD such as hospitalization and need for surgery. The endpoints were investigated at 2 time points, 6 to 12 months (short term) and >12 months (long term).
Short-term outcome analysis showed that the risk of clinical relapse was significantly higher in ulcerative colitis patients with active histological disease in comparison with patients at histological remission (risk ratio [RR], 2.41; 95% confidence interval [CI], 1.69-3.44; P < .01). The risk of hospitalization in ulcerative colitis patients was not significant among the 2 groups (RR, 4.22; 95% CI, 0.91-19.62; P = .07). Long-term outcome analysis demonstrated that the risk of clinical relapse (RR, 2.07; 95% CI, 1.55-2.76; P < .01), need for surgery (RR, 3.14; 95% CI, 1.53-6.45; P < .01), and hospitalization (RR, 2.52; 95% CI, 1.59-4.00; P < .01) was significantly higher in patients with active histological disease.
Histological remission in IBD represents an important therapeutic goal that is not yet routinely pursued in clinical practice. In our study, patients who achieved histological remission have more favorable outcomes than those with active histological disease in ulcerative colitis.
组织学缓解对炎症性肠病（IBD）患者的短期和长期临床结局的临床影响尚未得到充分证实。我们评估了在达到组织学缓解的患者与活动性组织学疾病患者相比，发生临床复发、住院和手术需求的风险。
系统检索了 MEDLINE、Scopus、Cochrane 中心、EMBASE 和会议摘要数据库，从建库到 2022 年 11 月。我们的主要结局是达到组织学缓解的 IBD 患者与患有活动性组织学疾病的患者相比，临床复发的发生率。次要结局是 IBD 的临床并发症，如住院和手术需求。终点在 2 个时间点进行评估，6-12 个月（短期）和>12 个月（长期）。
短期结局分析显示，与组织学缓解患者相比，溃疡性结肠炎活动组织学疾病患者的临床复发风险显著更高（风险比[RR]，2.41；95%置信区间[CI]，1.69-3.44；P<0.01）。2 组患者的住院风险无显著差异（RR，4.22；95%CI，0.91-19.62；P=0.07）。长期结局分析表明，临床复发风险（RR，2.07；95%CI，1.55-2.76；P<0.01）、手术需求（RR，3.14；95%CI，1.53-6.45；P<0.01）和住院（RR，2.52；95%CI，1.59-4.00；P<0.01）在活动性组织学疾病患者中显著更高。
IBD 的组织学缓解代表了一个尚未在临床实践中常规追求的重要治疗目标。在我们的研究中，与活动性组织学疾病患者相比，达到组织学缓解的溃疡性结肠炎患者具有更好的结局。
