Intestinal Research

Original Article

Histologic healing and clinical outcomes in ulcerative colitis: Raymond Fueng-Hin Liang, Huiyu Lin, Cora Yuk-Ping Chau, Wee Chian Lim; Received April 21, 2024 Accepted July 22, 2024 Published online September 19, 2024; DOI: https://doi.org/10.5217/ir.2024.00058 [Epub ahead of print]

Abstract PDF PubReader ePub: Background/Aims
Growing evidence suggests histologic healing (HH) improves clinical outcomes in ulcerative colitis (UC) patients beyond endoscopic healing (EH). We hypothesize that HH is associated with better clinical outcomes in Asian UC patients, for whom data is lacking.
Methods
We performed a retrospective study of UC patients in clinical remission (CR) with a follow-up colonoscopy and minimum 1-year follow-up post-colonoscopy. Primary outcome was clinical relapse (CRL), defined as either a Simple Clinical Colitis Activity Index score of > 2, medication escalation, hospitalization or colectomy. Predictors of CRL and HH were assessed.
Results
One hundred patients were included with a median follow-up of 22 months. At index colonoscopy, 80 patients were in EH. On follow-up, 41 patients experienced CRL. Of 80 patients in EH, 34 (42.5%) had persistent histologic activity (Nancy Index ≥ 2) and 29 (36.3%) relapsed during the follow-up period. Amongst patients in CR and EH, those with HH had lower CRL rate (26.1% vs. 50.0%, P= 0.028) and longer CRL-free survival (mean 46.1 months vs. 31.5 months, P= 0.015) than those with persistent histologic activity. On bivariable analysis of 100 patients in CR, HH, and Mayo endoscopic score (MES) of 0 were significantly associated with lower risk of CRL. On multivariable analysis, only MES 0 remained predictive of lower CRL risk.
Conclusions
Above and beyond CR and EH, achieving HH improves clinical outcomes in Asian UC patients. However, HH may not confer incremental benefit if MES 0 has been achieved. Further prospective studies evaluating the benefit of histologically guided therapeutic decisions are needed.

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Review

The evolving understanding of histology as an endpoint in ulcerative colitis: Shintaro Akiyama, Yusuke Miyatani, David T. Rubin; Received September 13, 2023 Accepted January 24, 2023 Published online March 13, 2024; DOI: https://doi.org/10.5217/ir.2023.00120 [Epub ahead of print]

Abstract PDF PubReader ePub

A therapeutic goal for patients with ulcerative colitis (UC) is deep remission including clinical remission and mucosal healing. Mucosal healing was previously defined by endoscopic appearance, but recent studies demonstrate that histological improvements can minimize the risks of experiencing clinical relapse after achieving endoscopic remission, and there is growing interest in the value and feasibility of histological targets of treatment in inflammatory bowel disease, and specifically UC. In this review article, we identify remaining challenges and discuss an evolving role of histology in the management of UC.

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Patients with ulcerative colitis who have normalized histology are clinically stable after de-escalation of therapy
Shintaro Akiyama, Joëlle St-Pierre, Cindy Traboulsi, Alexa Silfen, Victoria Rai, Tina G. Rodriguez, Amarachi I. Erondu, Joshua M. Steinberg, Seth R. Shaffer, Britt Christensen, David T. Rubin
npj Gut and Liver.2024;[Epub] CrossRef

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Statement

IBD

Proposal of novel staging system CNM (Crohn’s primary site, nodes, mesentery) to predict postoperative recurrence of Crohn’s disease: Guduru Venkat Rao, Partha Pal, Anuradha Sekaran, Pradeep Rebala, Manu Tandan, D. Nageshwar Reddy; Intest Res 2023;21(2):196-204. Published online August 8, 2022; DOI: https://doi.org/10.5217/ir.2022.00045

Abstract PDF PubReader ePub

After oncologic resection, histological grading and staging of the tumor give important prognostic information about the future risk of recurrence and hence influence the subsequent management plan. Several studies and their meta-analysis have shown that various histological features (e.g., microscopic positive resection margins, plexitis, granuloma, mesenteric inflammatory activity) can predict postoperative clinical/endoscopic/surgical recurrence after resection in Crohn’s disease (CD). Inclusion of mesentery in surgical resection specimens has been shown to reduce surgical recurrence after ileocolonic resection in CD. However, there is no uniform histopathological staging system for risk stratification in postoperative CD to systematically predict postoperative recurrence. This is because the prediction to date is based on clinical characteristics (smoking status, disease phenotype, surgical history). Histopathological predictors are still not adopted in routine clinical practice due to the lack of a uniform staging system, heterogeneity of published studies and lack of standardized definition of histological features. In this article, we attempted to incorporate all such histological features in a single histological staging system CNM (Crohn’s primary site [resection margin positivity, plexitis, granuloma, depth of infiltration], nodes [presence of granuloma], mesentery [involved or not]) in surgical resection specimen in CD. The proposed CNM classification would help to enable systematic reporting, design future clinical trials, stratify postoperative recurrence risk and choose appropriate postoperative prophylaxis.

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Citations to this article as recorded by

Endoscopic Assessment of Postoperative Recurrence in Crohn's Disease
Partha Pal, Duvvuru Nageshwar Reddy, Guduru Venkat Rao
Gastrointestinal Endoscopy Clinics of North America.2024;[Epub] CrossRef

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Original Articles

Inflammatory bowel diseases

Quantitative histology-based classification system for assessment of the intestinal mucosal histological changes in patients with celiac disease: Prasenjit Das, Gaurav PS Gahlot, Alka Singh, Vandana Baloda, Ramakant Rawat, Anil K Verma, Gaurav Khanna, Maitrayee Roy, Archana George, Ashok Singh, Aasma Nalwa, Prashant Ramteke, Rajni Yadav, Vineet Ahuja, Vishnubhatla Sreenivas, Siddhartha Datta Gupta, Govind K Makharia; Intest Res 2019;17(3):387-397. Published online April 22, 2019; DOI: https://doi.org/10.5217/ir.2018.00167

Abstract PDF PubReader ePub

Background/Aims
The existing histological classifications for the interpretation of small intestinal biopsies are based on qualitative parameters with high intraobserver and interobserver variations. We have developed and propose a quantitative histological classification system for the assessment of intestinal mucosal biopsies.
Methods
We performed a computer-assisted quantitative histological assessment of digital images of duodenal biopsies from 137 controls and 124 patients with celiac disease (CeD) (derivation cohort). From the receiver-operating curve analysis, followed by multivariate and logistic regression analyses, we identified parameters for differentiating control biopsies from those of the patients with CeD. We repeated the quantitative histological analysis in a validation cohort (105 controls and 120 patients with CeD). On the basis of the results, we propose a quantitative histological classification system. The new classification was compared with the existing histological classifications for interobserver and intraobserver agreements by a group of qualified pathologists.
Results
Among the histological parameters, intraepithelial lymphocyte count of ≥25/100 epithelial cells, adjusted villous height fold change of ≤0.7, and crypt depth-to-villous height ratio of ≥0.5 showed good discriminative power between the mucosal biopsies from the patients with CeD and those from the controls, with 90.3% sensitivity, 93.5% specificity, and 96.2% area under the curve. Among the existing histological classifications, our quantitative histological classification showed the highest intraobserver (69.7%–85.03%) and interobserver (24.6%–71.5%) agreements.
Conclusions
Quantitative assessment increases the reliability of the histological assessment of mucosal biopsies in patients with CeD. Such a classification system may be used for clinical trials in patients with CeD. (Intest Res, Published online)

Citations

Citations to this article as recorded by

Celiac Disease Deep Learning Image Classification Using Convolutional Neural Networks
Joaquim Carreras
Journal of Imaging.2024; 10(8): 200. CrossRef
CD, or not CD, that is the question: a digital interobserver agreement study in coeliac disease
James Denholm, Benjamin A Schreiber, Florian Jaeckle, Mike N Wicks, Emyr W Benbow, Tim S Bracey, James Y H Chan, Lorant Farkas, Eve Fryer, Kishore Gopalakrishnan, Caroline A Hughes, Kathryn J Kirkwood, Gerald Langman, Betania Mahler-Araujo, Raymond F T Mc
BMJ Open Gastroenterology.2024; 11(1): e001252. CrossRef
Role of Serology, Dietary Assessment, and Fecal Gluten Immunogenic Peptides for Predicting Histologic Recovery in Children with Celiac Disease
Keerthivasan Seetharaman, Sadhna Bhasin Lal, Kaushal Kishor Prasad, Yashwant Kumar, Alka Bhatia, Sunita Malhotra
Digestive Diseases and Sciences.2023; 68(2): 529. CrossRef
Usefulness of a double immunofluorescence technique for detection of intestinal tTG-IgA deposits in diabetic and non-diabetic children with celiac disease
Raghav Lal, Ranjeet Bhardwaj, Ranjana Walker Minz, Kaushal Kishore Prasad, Sadhna Lal, Devi Dayal, Yashwant Kumar
Pediatrics & Neonatology.2023; 64(4): 388. CrossRef
The global burden of coeliac disease: opportunities and challenges
Govind K. Makharia, Prashant Singh, Carlo Catassi, David S. Sanders, Daniel Leffler, Raja Affendi Raja Ali, Julio C. Bai
Nature Reviews Gastroenterology & Hepatology.2022; 19(5): 313. CrossRef
Gluten Induces Subtle Histological Changes in Duodenal Mucosa of Patients with Non-Coeliac Gluten Sensitivity: A Multicentre Study
Kamran Rostami, Arzu Ensari, Michael N. Marsh, Amitabh Srivastava, Vincenzo Villanacci, Antonio Carroccio, Hamid Asadzadeh Aghdaei, Julio C. Bai, Gabrio Bassotti, Gabriel Becheanu, Phoenix Bell, Camillo Di Bella, Anna Maria Bozzola, Moris Cadei, Giovanni
Nutrients.2022; 14(12): 2487. CrossRef
The Role of Nerve Fibers in the Tumor Immune Microenvironment of Solid Tumors
Sharia Hernandez, Alejandra G. Serrano, Luisa M. Solis Soto
Advanced Biology.2022;[Epub] CrossRef
Case Report: Morphologic and Functional Characteristics of Intestinal Mucosa in a Child With Short Bowel Syndrome After Treatment With Teduglutide: Evidence in Favor of GLP-2 Analog Safety
Enrico Costantino Falco, Antonella Lezo, Pierluigi Calvo, Caterina Rigazio, Anna Opramolla, Ludovica Verdun, Giovanna Cenacchi, Marianna Pellegrini, Marco Spada, Gabriella Canavese
Frontiers in Nutrition.2022;[Epub] CrossRef
Quantitative histology as a diagnostic tool for celiac disease in children and adolescents
Mateus M. Vargas, Ricardo Artigiani Neto, Vera L. Sdepanian
Annals of Diagnostic Pathology.2022; 61: 152031. CrossRef
Best practices of handling, processing, and interpretation of small intestinal biopsies for the diagnosis and management of celiac disease: A joint consensus of Indian association of pathologists and microbiologists and Indian society of gastroenterology
Prasenjit Das, Kim Vaiphei, AnjaliD Amarapurkar, Puja Sakhuja, Ritambhra Nada, RoopaRachel Paulose, Rachana Chaturvedi, Anuradha Sekaran, Usha Kini, Archana Rastogi, Niraj Kumari, Anna Pulimood, Mala Banerjee, Prateek Kinra, Lavleen Singh, AmarenderSingh
Indian Journal of Pathology and Microbiology.2021; 64(5): 8. CrossRef
Artificial intelligence in small intestinal diseases: Application and prospects
Yu Yang, Yu-Xuan Li, Ren-Qi Yao, Xiao-Hui Du, Chao Ren
World Journal of Gastroenterology.2021; 27(25): 3734. CrossRef
Opportunities and challenges in the management of celiac disease in Asia
Ashish Agarwal, Ashish Chauhan, Vineet Ahuja, Govind K Makharia
JGH Open.2020; 4(5): 795. CrossRef
Digital histology in celiac disease: A practice changer
Daniel Vasile Balaban, Mariana Jinga
Artificial Intelligence in Gastroenterology.2020; 1(1): 1. CrossRef
Digital histology in celiac disease: A practice changer
Daniel Vasile Balaban, Mariana Jinga
Artificial Intelligence in Gastroenterology.2020; 1(1): 1. CrossRef

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Endoscopy

Histologic discrepancy between endoscopic forceps biopsy and endoscopic mucosal resection specimens of colorectal polyp in actual clinical practice: Moon Joo Hwang, Kyeong Ok Kim, A Lim Kim, Si Hyung Lee, Byung Ik Jang, Tae Nyeun Kim; Intest Res 2018;16(3):475-483. Published online July 27, 2018; DOI: https://doi.org/10.5217/ir.2018.16.3.475

Abstract PDF PubReader ePub

<b>Background/Aims</b><br/>

We aimed to assess the rate of histologic discrepancy (HD) between endoscopic forceps biopsy (EFB) and totally resected specimens in colorectal polyp and analyze the risk factors of discordant group, especially under-diagnosis (UD) cases before complete removal of colorectal polyp.

Methods

From 2010 to 2015, a total of 290 polyps in 210 patients which had baseline pathology report before endoscopic resection (ER) were analyzed. UD cases were defined as those in which the diagnosis changed to a more advanced histologic feature after ER.

Results

A change in the final histology after ER was noted in 137 cases (47.2%), and after excluding 9 insignificant cases, 128 cases were further categorized into over-diagnosed and under-diagnosed group. UD occurred in 86 cases (29.7%) and change from benign to malignancy was noted in 26 cases (8.9%). On univariate analysis, a larger polyp size (>10 mm) was significantly associated with both HD (P<0.001) and UD (P<0.001). Regarding polyp morphology, protruding or flat was not significantly important. On multivariate analysis, polyp size >10 mm was the single most significant predictor of both HD (P<0.001) and UD (P<0.001).

Conclusions

The HD and UD rates were 47.2% and 29.7%, respectively. Polyp size >10 mm was the most important predictor of both HD and UD. We should be careful in making treatment strategy of colorectal polyp based on histologic report of EFB especially when the size of polyp is >10 mm.

Citations

Citations to this article as recorded by

Genetic Analysis of Biopsy Tissues from Colorectal Tumors in Patients with Ulcerative Colitis
Noriko Yamamoto, Yuji Urabe, Hikaru Nakahara, Takeo Nakamura, Daisuke Shimizu, Hirona Konishi, Kazuki Ishibashi, Misa Ariyoshi, Ryo Miyamoto, Junichi Mizuno, Takeshi Takasago, Akira Ishikawa, Akiyoshi Tsuboi, Hidenori Tanaka, Ken Yamashita, Yuichi Hiyama,
Cancers.2024; 16(19): 3271. CrossRef
Comparing efficacy and factors of postoperative bleeding in endoscopic mucosal resection vs coagulation for intestinal polyps
Zhiang Li, Fei Yu, Chaoqian Wang, Zhang Du
Medicine.2023; 102(37): e34941. CrossRef
“Unresectable” polyp management utilizing advanced endoscopic techniques results in high rate of colon preservation
Carey J. Wickham, Jennifer Wang, Kasim L. Mirza, Erik R. Noren, Joongho Shin, Sang W. Lee, Kyle G. Cologne
Surgical Endoscopy.2022; 36(3): 2121. CrossRef
Potential Factors Predicting Histopathologically Upgrade Discrepancies between Endoscopic Forceps Biopsy of the Colorectal Low-Grade Intraepithelial Neoplasia and Endoscopic Resection Specimens
Junbo Hong, Yining Wang, Jiangshan Deng, Miao Qi, Wei Zuo, Yuanzheng Hao, Anjiang Wang, Yi Tu, Shan Xu, Xiaodong Zhou, Xiaojiang Zhou, Guohua Li, Liang Zhu, Xu Shu, Yin Zhu, Nonghua Lv, Youxiang Chen, Li-kang Sun
BioMed Research International.2022; 2022: 1. CrossRef
Endoscopic vs optical biopsy for patients with colorectal lesions: prospective multicentral trial
K.D. Khalin, M.Yu. Agapov, E.D. Fedorov, L.V. Zvereva, N.E. Ogurchyonok, K.V. Stegnii, E.V. Ivanova, E.R. Dvoinikova, E.V. Gorbachev
Dokazatel'naya gastroenterologiya.2022; 11(3): 11. CrossRef
Long-term Outcomes of Primary Endoscopic Resection vs Surgery for T1 Colorectal Cancer: A Systematic Review and Meta-analysis
Jen-Hao Yeh, Cheng-Hao Tseng, Ru-Yi Huang, Chih-Wen Lin, Ching-Tai Lee, Po-Jen Hsiao, Tsung-Chin Wu, Liang-Tseng Kuo, Wen-Lun Wang
Clinical Gastroenterology and Hepatology.2020; 18(12): 2813. CrossRef
Prophylactic endoscopic coagulation to prevent delayed post-EMR bleeding in the colorectum: a prospective randomized controlled trial (with videos)
Hyun Seok Lee, Seong Woo Jeon, Yong Hwan Kwon, Su Youn Nam, Seonghwan Shin, Ryanghi Kim, Sohyun Ahn
Gastrointestinal Endoscopy.2019; 90(5): 813. CrossRef

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