Investigators concluded that both an Ulcerative Colitis Endoscopic Index of Severity (UCEIS) score of ≤1 and Mayo Endoscopic Subscore (MES) of 0 correlate poorly with histologic healing among patients with ulcerative colitis (UC), according to an eposter presented at Digestive Disease Week 2022 in San Diego, California, on May 21.

The investigators noted in their eposter, “Targets of therapy in ulcerative colitis (UC) have undergone a shift from clinical remission to endoscopic healing (EH). Recent STRIDE II guidelines have recommended stricter criteria for EH, Ulcerative Colitis Index of Severity (UCEIS) ≤1 or Mayo endoscopic subscore (MES)=0, with histologic healing (HH) as an adjunctive endpoint.”

The researchers performed a single-center cohort study in a tertiary institution among patients with a diagnosis of UC who were prospectively enrolled between January 2017 and June 2020. The team collected and analyzed patient demographics, clinical classification, endoscopic and histological assessments. Two independent gastroenterologists assessed the information and corroborated the endoscopic scores among those most severely affected.

Of 88 patients with UC who were enrolled, 7 patients were excluded due to the lack of biopsies performed during endoscopy. The study cohort included 55 males (67.9%). The median age of patients studied was 52.5 ± 15.5 years and mean duration of disease was 4.7 ± 7.1 years.

“All the grades of UCEIS, MES and Nancy Histologic Index (NHI) were represented within our cohort,” the study team stated. “Both MES and UCEIS had modest correlations with NHI but UCEIS had a stronger correlation to NHI (r=0.640, 95% CI 0.535-0.731, p<0.01) than MES (r=0.538, 95% CI 0.422-0.642, p<0.01). MES and UCEIS had good correlation (r=0.863, 95% CI 0.815-0.901, p<0.01).”

When evaluating patients in endoscopic healing, (UCEIS≤1 or MES=0), endoscopic scores of MES=0 and UCEIS of ≤1 had similar distribution of NHI scores.

“Despite appearing to be endoscopically inactive, more than half of patients had histologically active disease, with NHI≥2 (14/27 [51.8%] in the UCEIS≤1 group, 9/17 [52.9%] in the MES=0 group). When using the previous STRIDE definition of EH (MES≤1), 49 of 66 patients (74%) had histologically active disease with NHI≥2,” the team reported.

The researchers stated, “Biopsies should still be performed if HH [histologic healing] is a desired treatment outcome.” They also called for further research to corroborate their findings.

—Rebecca Mashaw

Reference:
Tay SW, Teh KKJ, Wang LM, Tan M. Ulcerative colitis index of severity is a better predictor of histologic activity than mayo endoscopic subscore: An Asian cohort study in ulcerative colitis. Presentation Number: EP1289  Presented at: Digestive Disease Week; May 21, 2022. San Diego, CA.