Article Text

Download PDFPDF
Correspondence on “PICaSSO Histologic Remission Index (PHRI) in ulcerative colitis: development of a novel simplified histological score for monitoring mucosal healing and predicting clinical outcomes and its applicability in an artificial intelligence system” by Gui et al
  1. Emily C L Wong1,
  2. Parambir S Dulai2,
  3. Neeraj Narula1
  1. 1 Department of Medicine (Division of Gastroenterology), McMaster University, Hamilton, Ontario, Canada
  2. 2 Division of Gastroenterology, Northwestern University, Chicago, Illinois, USA
  1. Correspondence to Dr Neeraj Narula, Department of Medicine (Division of Gastroenterology), McMaster University, Hamilton, Canada; neeraj.narula{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

We read with great interest the study conducted by Gui et al,1 which developed a simplified histologic score (PICaSSO Histologic Remission Index (PHRI)) that only considers the presence of neutrophils in the epithelium and lamina propria.1 Many definitions of histologic remission (HR) have been proposed,2 3 and the absence of neutrophilic infiltration plays a key role in HR.4 5 In a post-hoc analysis of the VARSITY trial (NCT02497469),6 we observed that early changes in epithelial neutrophil involvement performed the best for predicting 1-year mucosal healing (MH) (area under the curve (AUC): 0.83, 95% CI 0.74 to 0.91) and histo-endoscopic mucosal improvement (HEMI) (AUC: 0.85, 95% CI: 0.76 to 0.94).7 Multivariate analyses demonstrated that improvement or lack thereof of epithelial neutrophilic infiltration was the only histologic component associated with 1-year MH and HEMI.

The sole reliance on neutrophilic infiltration as an indicator of HR is an appealing option given its simplicity. However, the question remains how accurately this captures true histologic disease activity. To validate this novel score, we performed a post-hoc analysis of 573 patients with 1-year …

View Full Text


  • Contributors ECLW: study concept and design; acquisition and compilation of data; statistical analysis; and drafting of the manuscript. PSD: data interpretation and drafting of the manuscript. NN: study concept and design; acquisition and compilation of data; statistical analysis; data interpretation; and drafting of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests PSD has received consulting and/or research support from Takeda, Pfizer, Janssen, BMS, Gilead, Novartis and Lily, stock options from DigbiHealth and royalty from PreciDiag. NN holds a McMaster University's Department of Medicine Internal Career Award and has received honoraria from Janssen, Abbvie, Takeda, Pfizer, Merck, Sandoz, Novartis and Ferring.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Linked Articles