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Observational Study
. 2017 Dec;66(12):2063-2068.
doi: 10.1136/gutjnl-2016-312307. Epub 2016 Sep 2.

Discrepancies between patient-reported outcomes, and endoscopic and histological appearance in UC

Jean-Frédéric Colombel  1 , Mary E Keir  2 , Alexis Scherl  2 , Rui Zhao  2 , Gert de Hertogh  3 , William A Faubion  4 , Timothy T Lu  2
Affiliations
Observational Study

Discrepancies between patient-reported outcomes, and endoscopic and histological appearance in UC

Jean-Frédéric Colombel et al. Gut. 2017 Dec.

Abstract

Objective: Both endoscopy and histology may be included in the definition of mucosal healing in UC. This study aimed to establish the association between patient-reported outcomes, specifically symptom measures, and the presence of inflammation as measured by endoscopy and histology in UC.

Design: Using patient data from an observational multicentre study of UC (n=103), rectal bleeding (RB) and stool frequency (SF) symptom subscores of the Mayo Clinic Score (MCS) were compared with the endoscopic subscore (MCSe) and histology. Faecal calprotectin and biopsy cytokine expression were also evaluated.

Results: When identifying UC patients with inactive disease, RB scores were superior to SF scores and the combination (sensitivity/specificity: MCSe=0/1, RB 77%/81%, SF 62%/95%, RB+SF 54%/95%; MCSe=0, RB 87%/66%, SF 76%/83%, RB+SF 68%/86%). Across different definitions of mucosal healing (MCSe≤1; 0; or 0 plus inactive histology), a larger subset of patients reported increased SF (39%, 25% and 27%, respectively) compared with RB (24%, 13% and 10%). Faecal calprotectin and inflammatory cytokine expression were higher in patients with active disease compared with patients with mucosal healing, but there were no differences between patients using increasingly stringent definitions of mucosal healing.

Conclusions: Endoscopically inactive disease is associated with absence of RB but not with complete normalisation of SF. Achieving histological remission did not improve symptomatic relief. In addition, in these patients, higher inflammatory biomarker levels were not observed. These data suggest that non-inflammatory changes, such as bowel damage, may contribute to SF in UC.

Keywords: DIARRHOEA; ENDOSCOPY; GASTROINTESTINAL BLEEDING; HISTOPATHOLOGY; ULCERATIVE COLITIS.

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Conflict of interest statement

Competing interests: J-FC has received research funding Abbvie, Genentech, Janssen and Janssen, and Takeda and has served as a consultant for Abbvie, Amgen, Boehringer Ingelheim, Celgene Corporation, Celltrion, Enterome, Ferring, Genentech, Janssen Pharmaceuticals, Medimmune, Merck & Co., Pfizer, Protagonist, Second Genome, Seres, Takeda and Theradiag. He has also been a speaker for Abbvie, Ferring, Takeda and Shire. He has received stock options from Intestinal Biotech Development and Genfit. MEK, AS, RZ and TTL are employees of Genentech, a member of the Roche group and own Roche stock. GdH has received payment to his institution from Genentech for the central pathology review in this manuscript and his institution has received payment for his central pathology review services from Shire, Novartis, Centocor and Galapagos. WAF serves as an advisory board member for Abbvie, Janssen Pharmaceuticals and Boehringer Ingelheim Pharma and serves as a consultant for Celgene, Connecticut Children's Medical Center, Genentech, Janssen Pharmaceuticals, Shire and Velocity Pharmaceutical Development.

Figures

Figure 1
Figure 1
Proportion of patients with Mayo endoscopic subscores (MCSe)=0–3 by increasing (A) rectal bleeding (RB) and (B) stool frequency (SF) subscores.
Figure 2
Figure 2
Proportion of patients with (A) rectal bleeding (RB) and (B) stool frequency (SF) symptoms, grouped by increasingly stringent definitions of mucosal healing. MCSe, Mayo endoscopic subscores.
Figure 3
Figure 3
Faecal calprotectin (FCP) levels and symptom scores. (A) Box plots (median IQR) showing FCP levels in patients with active disease (Mayo endoscopic subscores (MCSe)≥2) or different definitions of mucosal healing (MCSe≤1, MCSe=0, MCSe=0/inactive histology). *p<0.01 by the Kruskal-Wallis test. Proportion of patients with (B) rectal bleeding (RB) and (C) stool frequency (SF) symptoms who have low FCP (≤150 µg/g) and mucosal healing (MCSe=0 or MCSe=0/inactive histology).
See this image and copyright information in PMC

References

    1. Danese S, Fiocchi C. Ulcerative colitis. N Engl J Med 2011;365:1713–25. 10.1056/NEJMra1102942 - DOI - PubMed
    1. Ordás I, Eckmann L, Talamini M, et al. . Ulcerative colitis. Lancet 2012;380:1606–19. 10.1016/S0140-6736(12)60150-0 - DOI - PubMed
    1. Jharap B, Sandborn WJ, Reinisch W, et al. . Randomised clinical study: discrepancies between patient-reported outcomes and endoscopic appearance in moderate to severe ulcerative colitis. Aliment Pharmacol Ther 2015;42:1082–92. 10.1111/apt.13387 - DOI - PMC - PubMed
    1. Riley SA, Mani V, Goodman MJ, et al. . Microscopic activity in ulcerative colitis: what does it mean? Gut 1991;32:174–8. 10.1136/gut.32.2.174 - DOI - PMC - PubMed
    1. Colombel JF, Rutgeerts P, Reinisch W, et al. . Early mucosal healing with infliximab is associated with improved long-term clinical outcomes in ulcerative colitis. Gastroenterology 2011;141:1194–201. 10.1053/j.gastro.2011.06.054 - DOI - PubMed

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