PT  - JOURNAL ARTICLE
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
TI  - Beyond endoscopic mucosal healing in UC: histological remission better predicts corticosteroid use and hospitalisation over 6 years of follow-up
AID  - 10.1136/gutjnl-2015-309598
DP  - 2016 Mar 01
TA  - Gut
PG  - 408--414
VI  - 65
IP  - 3
4099  - http://gut.bmj.com/content/65/3/408.short
4100  - http://gut.bmj.com/content/65/3/408.full
SO  - Gut2016 Mar 01; 65
AB  - 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’.