Skip to main content
Erschienen in: Virchows Archiv 1/2018

30.05.2017 | Original Article

Disease activity and mucosal healing in inflammatory bowel disease: a new role for histopathology?

verfasst von: Rish K. Pai, Karel Geboes

Erschienen in: Virchows Archiv | Ausgabe 1/2018

Einloggen, um Zugang zu erhalten

Abstract

Histologic evaluation of disease activity in the setting of inflammatory bowel disease is gaining interest within the gastroenterology community. Recent data suggests that histologic measurements of inflammation in ulcerative colitis are more sensitive at detecting disease activity and perform better than endoscopic measurements in predicting clinical outcomes. Histologic measurements are also increasingly used in ulcerative colitis clinical trials to assess response to new therapies. Histologic measurements of disease activity are less well studied in Crohn’s disease, but are gaining attention. Current published treatment algorithms in inflammatory bowel disease do not take into consideration histologic activity; however, this may change in the near future. In order for histologic measurements to be included in clinical decision-making, validated, reliable, and responsive histologic scoring systems are needed. In this review, the recent literature on the significance of histologic activity in both ulcerative colitis and Crohn’s disease is summarized. Histologic scoring systems are also briefly discussed.
Literatur
1.
Zurück zum Zitat Feagins LA, Melton SD, Iqbal R et al (2013) Clinical implications of histologic abnormalities in colonic biopsy specimens from patients with ulcerative colitis in clinical remission. Inflamm Bowel Dis 19:1477–1482. doi:10.1097/MIB.0b013e318281f4ae PubMed Feagins LA, Melton SD, Iqbal R et al (2013) Clinical implications of histologic abnormalities in colonic biopsy specimens from patients with ulcerative colitis in clinical remission. Inflamm Bowel Dis 19:1477–1482. doi:10.​1097/​MIB.​0b013e318281f4ae​ PubMed
4.
Zurück zum Zitat Peyrin-Biroulet L, Sandborn W, Sands BE et al (2015) Selecting therapeutic targets in inflammatory bowel disease (STRIDE): determining therapeutic goals for treat-to-target. Am J Gastroenterol 110:1324–1338. doi:10.1038/ajg.2015.233 PubMed Peyrin-Biroulet L, Sandborn W, Sands BE et al (2015) Selecting therapeutic targets in inflammatory bowel disease (STRIDE): determining therapeutic goals for treat-to-target. Am J Gastroenterol 110:1324–1338. doi:10.​1038/​ajg.​2015.​233 PubMed
7.
Zurück zum Zitat Schroeder KW, Tremaine WJ, Ilstrup DM (1987) Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study. N Engl J Med 317:1625–1629. doi:10.1056/NEJM198712243172603 PubMed Schroeder KW, Tremaine WJ, Ilstrup DM (1987) Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study. N Engl J Med 317:1625–1629. doi:10.​1056/​NEJM198712243172​603 PubMed
8.
Zurück zum Zitat D’Haens G, Sandborn WJ, Feagan BG et al (2007) A review of activity indices and efficacy end points for clinical trials of medical therapy in adults with ulcerative colitis. Gastroenterology 132:763–786. doi:10.1053/j.gastro.2006.12.038 PubMed D’Haens G, Sandborn WJ, Feagan BG et al (2007) A review of activity indices and efficacy end points for clinical trials of medical therapy in adults with ulcerative colitis. Gastroenterology 132:763–786. doi:10.​1053/​j.​gastro.​2006.​12.​038 PubMed
9.
Zurück zum Zitat Ulcerative colitis: clinical trial endpoints guidance for industry - UCM515143.pdf. Ulcerative colitis: clinical trial endpoints guidance for industry - UCM515143.pdf.
10.
Zurück zum Zitat Geboes K, Riddell R, Ost A et al (2000) A reproducible grading scale for histological assessment of inflammation in ulcerative colitis. Gut 47:404–409PubMedPubMedCentral Geboes K, Riddell R, Ost A et al (2000) A reproducible grading scale for histological assessment of inflammation in ulcerative colitis. Gut 47:404–409PubMedPubMedCentral
12.
Zurück zum Zitat Bessissow T, Lemmens B, Ferrante M et al (2012) Prognostic value of serologic and histologic markers on clinical relapse in ulcerative colitis patients with mucosal healing. Am J Gastroenterol 107:1684–1692. doi:10.1038/ajg.2012.301 PubMed Bessissow T, Lemmens B, Ferrante M et al (2012) Prognostic value of serologic and histologic markers on clinical relapse in ulcerative colitis patients with mucosal healing. Am J Gastroenterol 107:1684–1692. doi:10.​1038/​ajg.​2012.​301 PubMed
13.
14.
Zurück zum Zitat Zenlea T, Yee EU, Rosenberg L et al (2016) Histology grade is independently associated with relapse risk in patients with ulcerative colitis in clinical remission: a prospective study. Am J Gastroenterol 111:685–690. doi:10.1038/ajg.2016.50 PubMed Zenlea T, Yee EU, Rosenberg L et al (2016) Histology grade is independently associated with relapse risk in patients with ulcerative colitis in clinical remission: a prospective study. Am J Gastroenterol 111:685–690. doi:10.​1038/​ajg.​2016.​50 PubMed
15.
Zurück zum Zitat Bryant RV, Burger DC, Delo J et al (2016) Beyond endoscopic mucosal healing in UC: histological remission better predicts corticosteroid use and hospitalisation over 6 years of follow-up. Gut 65:408–414. doi:10.1136/gutjnl-2015-309598 PubMed Bryant RV, Burger DC, Delo J et al (2016) Beyond endoscopic mucosal healing in UC: histological remission better predicts corticosteroid use and hospitalisation over 6 years of follow-up. Gut 65:408–414. doi:10.​1136/​gutjnl-2015-309598 PubMed
16.
Zurück zum Zitat Kleer CG, Appelman HD (1998) Ulcerative colitis: patterns of involvement in colorectal biopsies and changes with time. Am J Surg Pathol 22:983–989PubMed Kleer CG, Appelman HD (1998) Ulcerative colitis: patterns of involvement in colorectal biopsies and changes with time. Am J Surg Pathol 22:983–989PubMed
17.
Zurück zum Zitat Wright R, Truelove SR (1966) Serial rectal biopsy in ulcerative colitis during the course of a controlled therapeutic trial of various diets. Am J Dig Dis 11:847–857PubMed Wright R, Truelove SR (1966) Serial rectal biopsy in ulcerative colitis during the course of a controlled therapeutic trial of various diets. Am J Dig Dis 11:847–857PubMed
18.
Zurück zum Zitat Bitton A, Peppercorn MA, Antonioli DA et al (2001) Clinical, biological, and histologic parameters as predictors of relapse in ulcerative colitis. Gastroenterology 120:13–20PubMed Bitton A, Peppercorn MA, Antonioli DA et al (2001) Clinical, biological, and histologic parameters as predictors of relapse in ulcerative colitis. Gastroenterology 120:13–20PubMed
19.
Zurück zum Zitat Christensen B, Hanauer SB, Erlich J et al (2017) Histologic normalization occurs in ulcerative colitis and is associated with improved clinical outcomes. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. doi:10.1016/j.cgh.2017.02.016 Christensen B, Hanauer SB, Erlich J et al (2017) Histologic normalization occurs in ulcerative colitis and is associated with improved clinical outcomes. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. doi:10.​1016/​j.​cgh.​2017.​02.​016
20.
Zurück zum Zitat Park S, Abdi T, Gentry M, Laine L (2016) Histological disease activity as a predictor of clinical relapse among patients with ulcerative colitis: systematic review and meta-analysis. Am J Gastroenterol 111:1692–1701. doi:10.1038/ajg.2016.418 PubMed Park S, Abdi T, Gentry M, Laine L (2016) Histological disease activity as a predictor of clinical relapse among patients with ulcerative colitis: systematic review and meta-analysis. Am J Gastroenterol 111:1692–1701. doi:10.​1038/​ajg.​2016.​418 PubMed
21.
Zurück zum Zitat Rutter M, Saunders B, Wilkinson K et al (2004) Severity of inflammation is a risk factor for colorectal neoplasia in ulcerative colitis. Gastroenterology 126:451–459PubMed Rutter M, Saunders B, Wilkinson K et al (2004) Severity of inflammation is a risk factor for colorectal neoplasia in ulcerative colitis. Gastroenterology 126:451–459PubMed
25.
Zurück zum Zitat Bryant RV, Winer S, Travis SPL, Riddell RH (2014) Systematic review: histological remission in inflammatory bowel disease. Is “complete” remission the new treatment paradigm? An IOIBD initiative. J Crohns Colitis 8:1582–1597. doi:10.1016/j.crohns.2014.08.011 PubMed Bryant RV, Winer S, Travis SPL, Riddell RH (2014) Systematic review: histological remission in inflammatory bowel disease. Is “complete” remission the new treatment paradigm? An IOIBD initiative. J Crohns Colitis 8:1582–1597. doi:10.​1016/​j.​crohns.​2014.​08.​011 PubMed
29.
30.
Zurück zum Zitat Truelove SC, Hambling MH (1958) Treatment of ulcerative colitis with local hydrocortisone hemisuccinate sodium; a report on a controlled therapeutic trial. Br Med J 2:1072–1077PubMedPubMedCentral Truelove SC, Hambling MH (1958) Treatment of ulcerative colitis with local hydrocortisone hemisuccinate sodium; a report on a controlled therapeutic trial. Br Med J 2:1072–1077PubMedPubMedCentral
33.
Zurück zum Zitat Gross V, Bunganic I, Belousova EA et al (2011) 3g mesalazine granules are superior to 9mg budesonide for achieving remission in active ulcerative colitis: a double-blind, double-dummy, randomised trial. J Crohns Colitis 5:129–138. doi:10.1016/j.crohns.2010.11.006 PubMed Gross V, Bunganic I, Belousova EA et al (2011) 3g mesalazine granules are superior to 9mg budesonide for achieving remission in active ulcerative colitis: a double-blind, double-dummy, randomised trial. J Crohns Colitis 5:129–138. doi:10.​1016/​j.​crohns.​2010.​11.​006 PubMed
34.
Zurück zum Zitat Kruis W, Kiudelis G, Rácz I et al (2009) Once daily versus three times daily mesalazine granules in active ulcerative colitis: a double-blind, double-dummy, randomised, non-inferiority trial. Gut 58:233–240. doi:10.1136/gut.2008.154302 PubMed Kruis W, Kiudelis G, Rácz I et al (2009) Once daily versus three times daily mesalazine granules in active ulcerative colitis: a double-blind, double-dummy, randomised, non-inferiority trial. Gut 58:233–240. doi:10.​1136/​gut.​2008.​154302 PubMed
35.
Zurück zum Zitat Magro F, Lopes SI, Lopes J et al (2016) Histological outcomes and predictive value of faecal markers in moderately to severely active ulcerative colitis patients receiving infliximab. J Crohns Colitis 10:1407–1416. doi:10.1093/ecco-jcc/jjw112 PubMed Magro F, Lopes SI, Lopes J et al (2016) Histological outcomes and predictive value of faecal markers in moderately to severely active ulcerative colitis patients receiving infliximab. J Crohns Colitis 10:1407–1416. doi:10.​1093/​ecco-jcc/​jjw112 PubMed
36.
38.
Zurück zum Zitat Baars JE, Nuij VJAA, Oldenburg B et al (2012) Majority of patients with inflammatory bowel disease in clinical remission have mucosal inflammation. Inflamm Bowel Dis 18:1634–1640. doi:10.1002/ibd.21925 PubMed Baars JE, Nuij VJAA, Oldenburg B et al (2012) Majority of patients with inflammatory bowel disease in clinical remission have mucosal inflammation. Inflamm Bowel Dis 18:1634–1640. doi:10.​1002/​ibd.​21925 PubMed
39.
Zurück zum Zitat Brennan GT, Melton SD, Spechler SJ, Feagins LA (2017) Clinical implications of histologic abnormalities in ileocolonic biopsies of patients with Crohn’s disease in remission. J Clin Gastroenterol 51:43–48. doi:10.1097/MCG.0000000000000507 PubMed Brennan GT, Melton SD, Spechler SJ, Feagins LA (2017) Clinical implications of histologic abnormalities in ileocolonic biopsies of patients with Crohn’s disease in remission. J Clin Gastroenterol 51:43–48. doi:10.​1097/​MCG.​0000000000000507​ PubMed
41.
Zurück zum Zitat Kotanagi H, Kramer K, Fazio VW, Petras RE (1991) Do microscopic abnormalities at resection margins correlate with increased anastomotic recurrence in Crohn’s disease? Retrospective analysis of 100 cases. Dis Colon rectum 34:909–916 Kotanagi H, Kramer K, Fazio VW, Petras RE (1991) Do microscopic abnormalities at resection margins correlate with increased anastomotic recurrence in Crohn’s disease? Retrospective analysis of 100 cases. Dis Colon rectum 34:909–916
42.
Zurück zum Zitat Fazio VW, Marchetti F, Church M et al (1996) Effect of resection margins on the recurrence of Crohn’s disease in the small bowel. A randomized controlled trial. Ann Surg 224:563–573PubMedPubMedCentral Fazio VW, Marchetti F, Church M et al (1996) Effect of resection margins on the recurrence of Crohn’s disease in the small bowel. A randomized controlled trial. Ann Surg 224:563–573PubMedPubMedCentral
43.
Zurück zum Zitat Wolff BG, Beart RW, Frydenberg HB et al (1983) The importance of disease-free margins in resections for Crohn’s disease. Dis Colon rectum 26:239–243 Wolff BG, Beart RW, Frydenberg HB et al (1983) The importance of disease-free margins in resections for Crohn’s disease. Dis Colon rectum 26:239–243
44.
Zurück zum Zitat Decousus S, Boucher A-L, Joubert J et al (2016) Myenteric plexitis is a risk factor for endoscopic and clinical postoperative recurrence after ileocolonic resection in Crohn’s disease. Dig Liver Dis Off J Ital Soc Gastroenterol Ital Assoc Study Liver 48:753–758. doi:10.1016/j.dld.2016.02.023 Decousus S, Boucher A-L, Joubert J et al (2016) Myenteric plexitis is a risk factor for endoscopic and clinical postoperative recurrence after ileocolonic resection in Crohn’s disease. Dig Liver Dis Off J Ital Soc Gastroenterol Ital Assoc Study Liver 48:753–758. doi:10.​1016/​j.​dld.​2016.​02.​023
45.
Zurück zum Zitat Lemmens B, de Buck van Overstraeten A, Arijs I et al (2017) Submucosal plexitis as a predictive factor for postoperative endoscopic recurrence in patients with Crohn’s disease undergoing a resection with ileocolonic anastomosis: results from a prospective single-centre study. J Crohns Colitis 11:212–220. doi:10.1093/ecco-jcc/jjw135 PubMed Lemmens B, de Buck van Overstraeten A, Arijs I et al (2017) Submucosal plexitis as a predictive factor for postoperative endoscopic recurrence in patients with Crohn’s disease undergoing a resection with ileocolonic anastomosis: results from a prospective single-centre study. J Crohns Colitis 11:212–220. doi:10.​1093/​ecco-jcc/​jjw135 PubMed
46.
47.
Zurück zum Zitat Rahier J-F, Dubuquoy L, Colombel J-F et al (2013) Decreased lymphatic vessel density is associated with postoperative endoscopic recurrence in Crohn’s disease. Inflamm Bowel Dis 19:2084–2090. doi:10.1097/MIB.0b013e3182971cec PubMed Rahier J-F, Dubuquoy L, Colombel J-F et al (2013) Decreased lymphatic vessel density is associated with postoperative endoscopic recurrence in Crohn’s disease. Inflamm Bowel Dis 19:2084–2090. doi:10.​1097/​MIB.​0b013e3182971cec​ PubMed
48.
Zurück zum Zitat Anseline PF, Wlodarczyk J, Murugasu R (1997) Presence of granulomas is associated with recurrence after surgery for Crohn’s disease: experience of a surgical unit. Br J Surg 84:78–82PubMed Anseline PF, Wlodarczyk J, Murugasu R (1997) Presence of granulomas is associated with recurrence after surgery for Crohn’s disease: experience of a surgical unit. Br J Surg 84:78–82PubMed
49.
Zurück zum Zitat Denoya P, Canedo J, Berho M et al (2011) Granulomas in Crohn’s disease: does progression through the bowel layers affect presentation or predict recurrence? Colorectal Dis Off J Assoc Coloproctology G B Irel 13:1142–1147. doi:10.1111/j.1463-1318.2010.02421.x Denoya P, Canedo J, Berho M et al (2011) Granulomas in Crohn’s disease: does progression through the bowel layers affect presentation or predict recurrence? Colorectal Dis Off J Assoc Coloproctology G B Irel 13:1142–1147. doi:10.​1111/​j.​1463-1318.​2010.​02421.​x
50.
Zurück zum Zitat Wolfson DM, Sachar DB, Cohen A et al (1982) Granulomas do not affect postoperative recurrence rates in Crohn’s disease. Gastroenterology 83:405–409PubMed Wolfson DM, Sachar DB, Cohen A et al (1982) Granulomas do not affect postoperative recurrence rates in Crohn’s disease. Gastroenterology 83:405–409PubMed
52.
Zurück zum Zitat D’Haens GR, Geboes K, Peeters M et al (1998) Early lesions of recurrent Crohn’s disease caused by infusion of intestinal contents in excluded ileum. Gastroenterology 114:262–267PubMed D’Haens GR, Geboes K, Peeters M et al (1998) Early lesions of recurrent Crohn’s disease caused by infusion of intestinal contents in excluded ileum. Gastroenterology 114:262–267PubMed
53.
Zurück zum Zitat Agnholt J, Dahlerup JF, Buntzen S et al (2003) Response, relapse and mucosal immune regulation after infliximab treatment in fistulating Crohn’s disease. Aliment Pharmacol Ther 17:703–710PubMed Agnholt J, Dahlerup JF, Buntzen S et al (2003) Response, relapse and mucosal immune regulation after infliximab treatment in fistulating Crohn’s disease. Aliment Pharmacol Ther 17:703–710PubMed
54.
55.
Zurück zum Zitat Mantzaris GJ, Christidou A, Sfakianakis M et al (2009) Azathioprine is superior to budesonide in achieving and maintaining mucosal healing and histologic remission in steroid-dependent Crohn’s disease. Inflamm Bowel Dis 15:375–382. doi:10.1002/ibd.20777 PubMed Mantzaris GJ, Christidou A, Sfakianakis M et al (2009) Azathioprine is superior to budesonide in achieving and maintaining mucosal healing and histologic remission in steroid-dependent Crohn’s disease. Inflamm Bowel Dis 15:375–382. doi:10.​1002/​ibd.​20777 PubMed
56.
Zurück zum Zitat Geboes K, Rutgeerts P, Opdenakker G et al (2005) Endoscopic and histologic evidence of persistent mucosal healing and correlation with clinical improvement following sustained infliximab treatment for Crohn’s disease. Curr Med Res Opin 21:1741–1754. doi:10.1185/030079905X65457 PubMed Geboes K, Rutgeerts P, Opdenakker G et al (2005) Endoscopic and histologic evidence of persistent mucosal healing and correlation with clinical improvement following sustained infliximab treatment for Crohn’s disease. Curr Med Res Opin 21:1741–1754. doi:10.​1185/​030079905X65457 PubMed
57.
Zurück zum Zitat Naini BV, Cortina G (2012) A histopathologic scoring system as a tool for standardized reporting of chronic (ileo) colitis and independent risk assessment for inflammatory bowel disease. Hum Pathol 43:2187–2196. doi:10.1016/j.humpath.2012.03.008 PubMed Naini BV, Cortina G (2012) A histopathologic scoring system as a tool for standardized reporting of chronic (ileo) colitis and independent risk assessment for inflammatory bowel disease. Hum Pathol 43:2187–2196. doi:10.​1016/​j.​humpath.​2012.​03.​008 PubMed
58.
Zurück zum Zitat Reinisch W, Colombel J-F, D’Haens G et al (2016) Characterisation of mucosal healing with adalimumab treatment in patients with moderately to severely active Crohn’s disease: results from the EXTEND Trial. J Crohns Colitis. doi:10.1093/ecco-jcc/jjw178 Reinisch W, Colombel J-F, D’Haens G et al (2016) Characterisation of mucosal healing with adalimumab treatment in patients with moderately to severely active Crohn’s disease: results from the EXTEND Trial. J Crohns Colitis. doi:10.​1093/​ecco-jcc/​jjw178
59.
Zurück zum Zitat Saverymuttu SH, Camilleri M, Rees H, et al (1986) Indium 111-granulocyte scanning in the assessment of disease extent and disease activity in inflammatory bowel disease. A comparison with colonoscopy, histology, and fecal indium 111-granulocyte excretion. Gastroenterology 90:1121–1128 Saverymuttu SH, Camilleri M, Rees H, et al (1986) Indium 111-granulocyte scanning in the assessment of disease extent and disease activity in inflammatory bowel disease. A comparison with colonoscopy, histology, and fecal indium 111-granulocyte excretion. Gastroenterology 90:1121–1128
60.
Zurück zum Zitat Riley SA, Mani V, Goodman MJ, et al (1991) Microscopic activity in ulcerative colitis: what does it mean? Gut 32:174–178 Riley SA, Mani V, Goodman MJ, et al (1991) Microscopic activity in ulcerative colitis: what does it mean? Gut 32:174–178
61.
Zurück zum Zitat Feagan BG, Greenberg GR, Wild G, et al (2005) Treatment of ulcerative colitis with a humanized antibody to the alpha4beta7 integrin. N Engl J Med 352:2499–2507. doi:10.1056/NEJMoa042982 Feagan BG, Greenberg GR, Wild G, et al (2005) Treatment of ulcerative colitis with a humanized antibody to the alpha4beta7 integrin. N Engl J Med 352:2499–2507. doi:10.​1056/​NEJMoa042982
62.
Zurück zum Zitat Rubin DT, Huo D, Hetzel JT, et al (2007) Increased degree of histological inflammation predicts colectomy and hospitalization in patients with ulcerative colitis. Gatroenterology 132:A19 Rubin DT, Huo D, Hetzel JT, et al (2007) Increased degree of histological inflammation predicts colectomy and hospitalization in patients with ulcerative colitis. Gatroenterology 132:A19
64.
Zurück zum Zitat Colombel JF, Solem CA, Sandborn WJ, et al (2006) Quantitative measurement and visual assessment of ileal Crohn’s disease activity by computed tomography enterography: correlation with endoscopic severity and C reactive protein. Gut 55:1561–1567. doi:10.1136/gut.2005.084301 Colombel JF, Solem CA, Sandborn WJ, et al (2006) Quantitative measurement and visual assessment of ileal Crohn’s disease activity by computed tomography enterography: correlation with endoscopic severity and C reactive protein. Gut 55:1561–1567. doi:10.​1136/​gut.​2005.​084301
Metadaten
Titel
Disease activity and mucosal healing in inflammatory bowel disease: a new role for histopathology?
verfasst von
Rish K. Pai
Karel Geboes
Publikationsdatum
30.05.2017
Verlag
Springer Berlin Heidelberg
Erschienen in
Virchows Archiv / Ausgabe 1/2018
Print ISSN: 0945-6317
Elektronische ISSN: 1432-2307
DOI
https://doi.org/10.1007/s00428-017-2156-5

Weitere Artikel der Ausgabe 1/2018

Virchows Archiv 1/2018 Zur Ausgabe

Neu im Fachgebiet Pathologie