TY - JOUR T1 - Beyond endoscopic mucosal healing in UC: histological remission better predicts corticosteroid use and hospitalisation over 6 years of follow-up JF - Gut JO - Gut SP - 408 LP - 414 DO - 10.1136/gutjnl-2015-309598 VL - 65 IS - 3 AU - Robert V Bryant AU - Daniel C Burger AU - Joseph Delo AU - Alissa J Walsh AU - Sally Thomas AU - Axel von Herbay AU - Otto C Buchel AU - Lydia White AU - Oliver Brain AU - Satish Keshav AU - Bryan F Warren AU - Simon P L Travis Y1 - 2016/03/01 UR - http://gut.bmj.com/content/65/3/408.abstract N2 - Background Endoscopic mucosal healing is an established treatment target for UC, yet the value of achieving histological remission remains unclear.Aims To evaluate histological remission compared to endoscopic mucosal healing for predicting patient outcomes in UC.Methods Blinded assessment of endoscopic and histological measures of disease activity was performed on patients with established UC at baseline. Concordance and prognostic values of endoscopic mucosal healing (defined by Baron score ≤1) and histological remission (defined by Truelove and Richards’ index) for predicting outcomes of corticosteroid use, hospitalisation and colectomy were determined over a median 6 years follow-up, including κ statistics and Cox regression multivariate analysis.Results 91 patients with UC were followed up for a median 72 months (IQR 54–75 months). Overall, concordance between endoscopic and histological remission was moderate (κ=0.56, 95% CI 0.36 to 0.77); 24% patients had persistent inflammation despite endoscopic remission. Histological remission predicted corticosteroid use and acute severe colitis requiring hospitalisation over the follow-up period (HR 0.42 (0.2 to 0.9), p=0.02; HR 0.21 (0.1 to 0.7), p=0.02; respectively), whereas endoscopic mucosal healing did not (HR 0.86, 95% CI 0.5 to 1.7, p0.65; HR 0.83 95% CI 0.3 to 2.4, p0.74; respectively).Conclusions Histological remission is a target distinct from endoscopic mucosal healing in UC and better predicts lower rates of corticosteroid use and acute severe colitis requiring hospitalisation, over a median of 6 years of follow-up. Our findings support the inclusion of histological indices in both UC clinical trials and practice, towards a target of ‘complete remission’. ER -