Segmental Histological Normalisation Occurs in Ulcerative Colitis but Does Not Improve Clinical Outcomes
Segmental Histological Normalisation Occurs in Ulcerative Colitis but Does Not Improve Clinical Outcomes
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DOI：
10.1093/ecco-jcc/jjaa068
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发表时间：
2020-10-01
影响因子：
8
通讯作者：
Rubin, David T.
中科院分区：
文献类型：
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作者：
Christensen, Britt;Hanauer, Stephen B.;Rubin, David T.
背景和目的：溃疡性结肠炎患者的完全组织学正常化和炎症严重程度的降低与临床结果的改善有关，但仅对先前受影响的肠段正常化的临床意义尚不清楚。我们研究了溃疡性结肠炎患者的患病率、模式、预测因素和与节段性组织学正常化相关的临床结果。方法：检索确诊的溃疡性结肠炎患者和不止一次结肠镜检查的病历。节段性组织学正常化被定义为先前有慢性组织学损伤证据的肠段[直肠、左侧或右侧结肠]的组织学正常化。我们评估了影响这些结果的变量，以及节段性正常化是否与临床结果的改善有关。结果：在646名患者中，32%的节段性正常化和10%的完全组织学正常化与他们的最大病变范围相比。大多数[88%]在近、远端方向节段正常化。其他人则有远端至近端或零星的正常化。在多变量分析中，只有当前吸烟[p=0.040]和确诊年龄5.16岁[p=0.028]预测节段性组织学正常化。在初次结肠镜检查时临床缓解的310人中，77人(25%)在中位数1.3年[范围0.06-7.52]年后临床复发。只有肠道组织学完全正常化才能提高无复发生存率(风险比[HR]0.23；95%可信区间[CI]0.08-0.68；p=0.008)。结论：32%的溃疡性结肠炎患者有节段性组织学正常化，吸烟或年轻诊断的患者增加。与完全的组织学正常化不同，节段性正常化并不意味着临床结果的改善。
Background and Aims: Complete histological normalisation and reduction of inflammation severity in patients with ulcerative colitis are associated with improved clinical outcomes, but the clinical significance of normalisation of only segments of previously affected bowel is not known. We examined the prevalence, pattern, predictors, and clinical outcomes associated with segmental histological normalisation in in patients with ulcerative colitis.Methods: Medical records of patients with confirmed ulcerative colitis and more than one colonoscopy were sought. Segmental histological normalisation was defined as histological normalisation of a bowel segment [rectum, left-sided or right-sided colon] that had previous evidence of chronic histological injury. We assessed the variables influencing these findings and whether segmental normalisation was associated with improved clinical outcomes.Results: Of 646 patients, 32% had segmental and 10% complete histological normalisaton when compared with their maximal disease extent. Most [88%] had segmental normalisation in a proximalto-distal direction. Others had distal-to-proximal or patchy normalisation. On multivariate analysis, only current smoking [p = 0.040] and age of diagnosis 5.16 years [p = 0.028] predicted segmental histological normalisation. Of 310 who were in clinical remission at initial colonoscopy, 77 [25%] experienced clinical relapse after median 1.3 [range 0.06-7.52] years. Only complete histological normalisation of the bowel was associated with improved relapse-free survival (hazard ratio [HR] 0.23; 95% confidence interval [CI] 0.08-0.68; p= 0.008].Conclusions: Segmental histological normalisation occurs in 32% of patients with ulcerative colitis and is increased in those who smoke or were diagnosed at younger age. Unlike complete histological normalisation, segmental normalisation does not signal improved clinical outcomes.