THE IMPACT OF THE SEVERITY OF MICROSCOPIC INFLAMMATION AT THE TIME OF DIAGNOSIS IN UC-RELATED OUTCOMES DURING FOLLOW-UP
Catarina F. Gomes*1, Pierre Ellul2, Alexandra Almeida9, Barbara Morão1, Catarina F. Gouveia1, Catarina Callé3, Tiffany Buhagiar2, Abigail Attard2, Joana C. Branco4, Jaime Rodrigues5, Cristina Teixeira6, Francisca Dias de Castro7, Gonçalo Nunes8, Mariana Brito8, Marília Antunes9, Marília Cravo1, Paula Borralho3, Joana Torres1
1Hospital Beatriz Ângelo, Lisbon, Portugal; 2Mater Dei Hospital, Malta, Malta; 3Hospital CUF Descobertas, Lisbon, Portugal; 4Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal; 5Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; 6Centro Hospitalar de Setúbal, Lisbon, Portugal; 7Hospital da Senhora da Oliveira, Guimarães, Portugal; 8Hospital Garcia de Orta, Almada, Portugal; 9Faculty of Sciences of University of Lisbon, Lisbon, Portugal
Introduction: Several studies have reported that the presence of histological inflammation in patients with ulcerative colitis affects prognosis and important UC-related outcomes. However, the prognostic value of histologic inflammation at the time of diagnosis is not well characterized, and histology is not currently used to assess prognosis in UC patients. Purpose: Review the microscopic features at the time of UC diagnosis, and to assess its prognostic value during follow-up. Methods: Multicenter restrospective study. Biopsies obtained from the rectum in newly-diagnosed, treatment-naïve patients with proctitis (E1) and left-sided colitis (E2) were obtained. Pathology slides were reviewed by 2 independent pathologists and classified according to the Nancy score, grading from 0 (mild chronic inflammation) to 4 (ulcers). The impact of the severity of inflammation at diagnosis on a composite outcome (need for hospitalization, steroids, and therapy escalation, acute severe UC, or proximal disease extension) was evaluated using chi-square analysis. Wilcoxon test was performed to evaluate the performance of Nancy score in time to an adverse outcome. Results: 48 patients were included (56,3% men, median age at diagnosis 47 years [17-66], median follow-up 1389 days [67-9836]). 64,6% were classified as proctitis (E1) and 35,4% as left-sided colitis (E2). The histologic features found in the inflamed rectal mucosa were: marked chronic inflammation in 75%, moderate to severe basal plasmocytosis in 70,9%, moderate to severe neutrophils invasion in lamina propria in 60,5%, moderate to severe mucin depletion in 79,2% and ulcers in 27,1%. During the follow-up, 13/48 cases had an adverse outcome: 7/48 needed steroids, 2/48 were hospitalised, 1/48 had an acute episode of severe UC, 4/48 had proximal endoscopic extension, and 9/48 escalated therapy. Moderate to severe histologic features were more frequent in patients who were hospitalized (2/2), had disease extension (4/ 4) and needed steroids (basal plasmocytosis (6/7), neutrophils in lamina propria (5/7) and mucin depletion (6/7). In a composite endpoint including all the outcomes, no significant association was found with basal plasmocytosis (p=0,18), mucin depletion (p=0,17) and neutrophils invasion in lamina propria (p=0,60). In the subgroup of patient developing an adverse outcome during follow-up, the median time to an adverse event was lower in Nancy scores ≥ 3 (781 vs 1567 days, p < 0,001). Conclusions: In our cohort of newly-diagnosed patients severe histological inflammation at the time of diagnosis, as assessed by the Nancy score, was associated with a lower median time to an adverse outcome, suggesting that histological information should also be incorporated to guide prognosis assessment and therapeutic choices.
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