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
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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.
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