医学
一致性
内科学
胃肠病学
结肠切除术
皮质类固醇
内窥镜检查
溃疡性结肠炎
外科
疾病
作者
Robert V. Bryant,Daniel Burger,Joseph Delo,Alissa Walsh,Sally Thomas,A. von Herbay,Otto C. Buchel,Lydia White,Oliver Brain,Satish Keshav,Bryan F. Warren,Simon Travis
出处
期刊:Gut
[BMJ]
日期:2015-05-18
卷期号:65 (3): 408-414
被引量:385
标识
DOI:10.1136/gutjnl-2015-309598
摘要
Background
Endoscopic mucosal healing is an established treatment target for UC, yet the value of achieving histological remission remains unclear. Aims
To evaluate histological remission compared to endoscopic mucosal healing for predicting patient outcomes in UC. Methods
Blinded assessment of endoscopic and histological measures of disease activity was performed on patients with established UC at baseline. Concordance and prognostic values of endoscopic mucosal healing (defined by Baron score ≤1) and histological remission (defined by Truelove and Richards’ index) for predicting outcomes of corticosteroid use, hospitalisation and colectomy were determined over a median 6 years follow-up, including κ statistics and Cox regression multivariate analysis. Results
91 patients with UC were followed up for a median 72 months (IQR 54–75 months). Overall, concordance between endoscopic and histological remission was moderate (κ=0.56, 95% CI 0.36 to 0.77); 24% patients had persistent inflammation despite endoscopic remission. Histological remission predicted corticosteroid use and acute severe colitis requiring hospitalisation over the follow-up period (HR 0.42 (0.2 to 0.9), p=0.02; HR 0.21 (0.1 to 0.7), p=0.02; respectively), whereas endoscopic mucosal healing did not (HR 0.86, 95% CI 0.5 to 1.7, p0.65; HR 0.83 95% CI 0.3 to 2.4, p0.74; respectively). Conclusions
Histological remission is a target distinct from endoscopic mucosal healing in UC and better predicts lower rates of corticosteroid use and acute severe colitis requiring hospitalisation, over a median of 6 years of follow-up. Our findings support the inclusion of histological indices in both UC clinical trials and practice, towards a target of ‘complete remission’.
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