Liang Raymond Fueng-Hin, Lin Huiyu, Chau Cora Yuk-Ping, Lim Wee Chian
Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore.
Department of Pathology, Tan Tock Seng Hospital, Singapore.
Intest Res. 2025 Apr;23(2):182-192. doi: 10.5217/ir.2024.00058. Epub 2024 Sep 19.
BACKGROUND/AIMS: Growing evidence suggests histologic healing (HH) improves clinical outcomes in ulcerative colitis (UC) patients beyond endoscopic healing (EH). We hypothesize that HH is associated with better clinical outcomes in Asian UC patients, for whom data is lacking.
We performed a retrospective study of UC patients in clinical remission (CR) with a follow-up colonoscopy and minimum 1-year follow-up post-colonoscopy. Primary outcome was clinical relapse (CRL), defined as either a Simple Clinical Colitis Activity Index score of > 2, medication escalation, hospitalization or colectomy. Predictors of CRL and HH were assessed.
One hundred patients were included with a median follow-up of 22 months. At index colonoscopy, 80 patients were in EH. On follow-up, 41 patients experienced CRL. Of 80 patients in EH, 34 (42.5%) had persistent histologic activity (Nancy Index ≥ 2) and 29 (36.3%) relapsed during the follow-up period. Amongst patients in CR and EH, those with HH had lower CRL rate (26.1% vs. 50.0%, P= 0.028) and longer CRL-free survival (mean 46.1 months vs. 31.5 months, P= 0.015) than those with persistent histologic activity. On bivariable analysis of 100 patients in CR, HH, and Mayo endoscopic score (MES) of 0 were significantly associated with lower risk of CRL. On multivariable analysis, only MES 0 remained predictive of lower CRL risk.
Above and beyond CR and EH, achieving HH improves clinical outcomes in Asian UC patients. However, HH may not confer incremental benefit if MES 0 has been achieved. Further prospective studies evaluating the benefit of histologically guided therapeutic decisions are needed.
背景/目的：越来越多的证据表明，组织学愈合（HH）比内镜愈合（EH）更能改善溃疡性结肠炎（UC）患者的临床结局。我们假设HH与亚洲UC患者更好的临床结局相关，而目前缺乏这方面的数据。
我们对处于临床缓解期（CR）的UC患者进行了一项回顾性研究，这些患者接受了随访结肠镜检查，且结肠镜检查后至少随访1年。主要结局是临床复发（CRL），定义为简单临床结肠炎活动指数评分>2、药物升级、住院或结肠切除术。评估了CRL和HH的预测因素。
纳入100例患者，中位随访时间为22个月。在初次结肠镜检查时，80例患者处于EH。随访期间，41例患者发生CRL。在80例处于EH的患者中，34例（42.5%）存在持续性组织学活动（南希指数≥2），29例（36.3%）在随访期间复发。在CR和EH患者中，HH患者的CRL发生率较低（26.1%对50.0%，P=0.028），无CRL生存期较长（平均46.1个月对31.5个月，P=0.015），而持续性组织学活动患者则相反。对100例处于CR的患者进行双变量分析，HH和梅奥内镜评分（MES）为0与较低的CRL风险显著相关。多变量分析显示，只有MES为0仍然是较低CRL风险的预测因素。
除了CR和EH之外，实现HH可改善亚洲UC患者的临床结局。然而，如果已达到MES为0，则HH可能不会带来额外益处。需要进一步的前瞻性研究来评估组织学指导治疗决策的益处。
