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  • Comparison of different histological indexes in the assessment of UC activity and their accuracy regarding endoscopic outcomes and faecal calprotectin levels

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Inflammatory bowel disease
Original article
Comparison of different histological indexes in the assessment of UC activity and their accuracy regarding endoscopic outcomes and faecal calprotectin levels
  1. Fernando Magro1,2,
  2. Joanne Lopes3,
  3. Paula Borralho4,
  4. Susana Lopes1,
  5. Rosa Coelho1,
  6. José Cotter5,
  7. Francisca Dias de Castro5,
  8. Helena Tavares de Sousa6,7,
  9. Marta Salgado8,
  10. Patrícia Andrade1,
  11. Ana Isabel Vieira9,
  12. Pedro Figueiredo9,
  13. Paulo Caldeira10,
  14. A Sousa10,
  15. Maria A Duarte11,
  16. Filipa Ávila11,
  17. João Silva12,
  18. Joana Moleiro12,
  19. Sofia Mendes13,
  20. Sílvia Giestas13,
  21. Paula Ministro14,
  22. Paula Sousa14,
  23. Raquel Gonçalves15,
  24. Bruno Gonçalves15,
  25. Ana Oliveira16,
  26. Isadora Rosa12,
  27. Marta Rodrigues3,
  28. Cristina Chagas17,
  29. Cláudia Camila Dias18,19,
  30. Joana Afonso2,20,
  31. Karel Geboes21,
  32. Fátima Carneiro3,22
  33. Portuguese IBD Study Group (GEDII)
  1. 1 Department of Gastroenterology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
  2. 2 Department of Biomedicine, Unity of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
  3. 3 Department of Pathology, Faculty of Medicine, Centro Hospitalar São João, Porto, Portugal
  4. 4 Institute of Pathology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
  5. 5 Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal
  6. 6 Department of Gastroenterology, Centro Hospitalar e Universitário do Algarve—Portimão Unit, Portimão, Portugal
  7. 7 Department of Medicine and Medical Biosciences, University of Algarve, Faro, Portugal
  8. 8 Department of Gastroenterology, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
  9. 9 Department of Gastroenterology, Hospital Garcia de Orta, Almada, Portugal
  10. 10 Department of Gastroenterology, Centro Hospitalar do Algarve, Faro, Portugal
  11. 11 Department of Gastroenterology, Divino Espírito Santo Hospital, Ponta Delgada, Portugal
  12. 12 Department of Gastroenterology, Instituto Português do Oncologia de Lisboa, Lisboa, Portugal
  13. 13 Department of Gastroenterology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  14. 14 Department of Gastroenterology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
  15. 15 Department of Gastroenterology, Hospital de Braga, Braga, Portugal
  16. 16 Department of Gastroenterology, Hospital Fernando Fonseca, Amadora, Portugal
  17. 17 Department of Gastroenterology, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
  18. 18 Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
  19. 19 CINTESIS- Centre for Health Technology and Services Research, Porto, Portugal
  20. 20 MedInUP, Centre for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
  21. 21 Department of Pathology, University Hospital of KU Leuven and UZ Gent, Leuven, Belgium
  22. 22 Institute of Molecular Pathology and Immunology of the University of Porto (Ipatimup), Instituto de Investigação e Inovação na Saúde (I3S), University of Porto, Porto, Portugal
  1. Correspondence to Professor Fernando Magro, Department of Biomedicine, Unity of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto 4250, Portugal; fm{at}med.up.pt

Abstract

Objective Histological remission is being increasingly acknowledged as a therapeutic endpoint in patients with UC. The work hereafter described aimed to evaluate the concordance between three histological classification systems—Geboes Score (GS), Nancy Index (NI) and RobartsHistopathologyIndex (RHI), as well as to evaluate their association with the endoscopic outcomes and the faecal calprotectin (FC) levels.

Design Biopsy samples from 377 patients with UC were blindly evaluated using GS, NI and RHI. The results were compared with the patients’ Mayo Endoscopic Score and FC levels.

Result GS, NI and RHI have a good concordance concerning the distinction between patients in histological remission or activity. RHI was particularly close to NI, with 100% of all patients classified as being in remission with NI being identified as such with RHI and 100% of all patients classified as having activity with RHI being identified as such with NI. These scores could also predict the Mayo Endoscopic Score and the FC levels, with their sensitivity and specificity levels depending on the chosen cut-offs. Moreover, higher FC levels were statistically associated with the presence of neutrophils in the epithelium, as well as with ulceration or erosion of the intestinal mucosa.

Conclusions GS, NI and RHI histopathological scoring systems are comparable in what concerns patients’ stratification into histological remission/activity. Additionally, FC levels are increased when neutrophils are present in the epithelium and the intestinal mucosa has erosions or ulcers. The presence of neutrophils in the epithelium is, indeed, the main marker of histological activity.

  • inflammatory bowel disease
  • stool markers
  • ulcerative colitis
  • histopathology

https://doi.org/10.1136/gutjnl-2017-315545

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    Footnotes

    • Contributors FM: Study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; study supervision; critical revision of the manuscript for important intellectual content. JA: faecal calprotectin assays; analysis and interpretation of data. JL: histological analysis. CCD: statistical analysis. KG: supervisor of the histological analysis; critical revision of the manuscript for important intellectual content. FC: responsible for the histological analysis; critical revision of the manuscript for important intellectual content. All the other authors: recruitment of patients and collection of samples. All authors read and approved the final version of the manuscript.

    • Funding This work was supported by the Portuguese IBD Group (GEDII—Grupo de Estudo da Doença Inflamatória Intestinal).

    • Competing interests FM served as speaker and received honoraria from Merck Sharp & Dohme, Abbvie, Vifor, Falk, Laboratorios Vitoria, Ferring, Hospira and Biogen. All other authors have nothing to declare.

    • Patient consent Obtained.

    • Ethics approval This study was approved by the ethic committee of all hospitals involved and by the Portuguese Data Protection Authority.

    • Provenance and peer review Not commissioned; externally peer reviewed.