J Crohns Colitis. 2021 Oct 7;15(10):1631-1640.doi: 10.1093/ecco-jcc/jjab063.

Ferdinando D'Amico ^1 2 3, Lucas Guillo ^3 4, Cedric Baumann ⁵, Silvio Danese ^1 2, Laurent Peyrin-Biroulet ³

Author information

¹Department of Biomedical Sciences, Humanitas University, Milan, Italy.

²IBD centre, Humanitas Research Hospital - IRCCS, Rozzano, Milan, Italy.

³Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France.

⁴Department of Gastroenterology, University Hospital of Marseille Nord, University of Aix-Marseille, Marseille, France.

⁵Methodology, Data Management and Statistic Unit, MPI Department, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France

Abstract

Background and aims: Histological healing might be the ultimate therapeutic goal in ulcerative colitis [UC]. Our aim was to investigate the association between histological disease activity as measured by a validated index and long-term outcomes in patients with UC.

Methods: An observational retrospective cohort study was conducted at the Nancy University Hospital between January 2014 and March 2020. All consecutive patients with confirmed UC, undergoing colonoscopy with biopsies and available histological reports, were eligible for inclusion.

Results: A total of 156 patients were included [53% female with a mean age of 41.3 ± 15.4 years]. About a quarter of patients were in histological remission [Nancy index = 0] at baseline [n = 42, 26.9%]. Median follow-up was 30.5 months [range 0-75]. Sixteen patients with histological disease activity at baseline [Nancy index ≥ 1] underwent surgery during follow-up compared with no subject in the histological remission group [14.0% vs 0.0%, respectively, p = 0.01]. Similarly, a higher rate of hospitalisation was found in patients with histological disease activity at baseline than in the histological remission group [36.0% vs 7.1%, respectively, p = 0.001]. The Kaplan-Meier analysis showed that patients with histological disease activity at baseline had a 5-year surgery rate of 16.7% [logrank p = 0.01] and a 5-year hospitalisation rate of 19.7% [logrank p = 0.0002]. In the multivariate regression model, Nancy index > 0 was independently associated with the risk of hospitalisation [hazard ratio 8.88, confidence interval 95% 2.5-31.1, p = 0.0007].

Conclusions: UC patients with histological disease activity, as measured by the Nancy index, have a greater risk of surgery and hospitalisation.