Korean J Intern Med.  2024 Jan;39(1):68-76. 10.3904/kjim.2023.167.

Histologic features and predicting prognosis in ulcerative colitis patients with mild endoscopic activity

• Shin SY
• Kim HS
• Kim K
• Choi CW
• Moon JM
• Kim JW
• Joo HJ
• Seo J
• Sung M
• Choi CH

• KMID: 2550041
• DOI: http://doi.org/10.3904/kjim.2023.167

Abstract

Background/Aims
We aimed to evaluate the histologic features predictive of prognosis and correlate them with endoscopic findings in patients with ulcerative colitis (UC) having complete or partial mucosal healing (MH).
Methods
We prospectively collected and reviewed data from patients with UC who underwent colonoscopy or sigmoidoscopy with biopsy. Complete and partial MH were defined as Mayo endoscopic subscores (MESs) of 0 and 1, respectively. Histologic variables, including the Nancy index (NI), predicting disease progression (defined as the need for medication upgrade or hospitalization/surgery), were evaluated and correlated with endoscopic findings.
Results
Overall, 441 biopsy specimens were collected from 194 patients. The average follow-up duration was 14.7 ± 7.4 months. There were 49 (25.3%) and 68 (35.1%) patients with MESs of 0 and 1, respectively. Disease progression occurred only in patients with an MES of 1. NI ≥ 3 was significantly correlated with disease progression during follow-up. Mucosal friability on endoscopy was significantly correlated with NI ≥ 3 (61.1% in NI < 3 vs. 88.0% in NI ≥ 3; p = 0.013).
Conclusions
Histological activity can help predict the prognosis of patients with UC with mild endoscopic activity. Mucosal friability observed on endoscopy may reflect a more severe histological status, which can be a risk factor for disease progression.

Keyword

Ulcerative colitis; Histology; Endoscopy; Prognosis