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HISTOLOGIC REMISSION PREDICTS ENDOSCOPIC REMISSION IN PATIENTS WITH ULCERATIVE COLITIS

Minjee Kim 1, Ji Eun Kim 1, Joo Hye Song 1, Eun-Ran Kim 1, Sung-Noh Hong 1, Dong Kyung Chang 1, Young-Ho Kim 1, Sang Yun Ha 1

Affiliations

1 Samsung Medical Center, Seoul, Korea, Republic of

Summary

AI Generated

In ulcerative colitis patients with Mayo endoscopic subscore 0 or 1, those achieving histologic remission are more likely to maintain endoscopic remission than those with persistent histologic activity.

A retrospective study of 492 ulcerative colitis patients at Samsung Medical Center (2018-2020) evaluated whether histologic activity predicts maintenance of endoscopic remission in patients with Mayo endoscopic subscore 0 or 1.
Histologic remission was defined as Geboes score less than 3.1, and endoscopic remission as Mayo endoscopic subscore of 0.
At median follow-up of 27.3 months, patients with histologic activity at index colonoscopy had significantly higher risk of endoscopic relapse than those with histologic remission (hazard ratio 1.63, P less than 0.001).
In subgroup analysis limited to patients without clinical relapse, histologic activity remained predictive of endoscopic relapse (hazard ratio 1.53, P equals 0.030).
This study addresses a gap in the literature, as prior work showed histologic activity predicts clinical relapse but no studies had examined prediction of endoscopic remission maintenance.

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Abstract

Introduction

Ulcerative colitis (UC) is an idiopathic chronic inflammatory bowel disease. The current goal of UC treatment is to modify the natural history of the disease and prevent long-term bowel damage and subsequent disability by using appropriate therapy and monitoring at appropriate intervals.
In 2015, the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) committee proposed a treat-to-target (T2T) approach and recommended that the therapeutic target in UC should be both clinical and patient-reported outcomes (PRO) remission as well as endoscopic remission with Mayo endoscopic subscore (MES) 0 and 1. However, in STRIDE II, only MES 0 of endoscopic remission is the treatment target and histologic remission is also considered to be a treatment target. Previous studies have demonstrated that patients who achieve an MES of 0 are more likely to have a longer duration of clinical remission than patients without endoscopic remission. Additionally, several studies have shown that histologic remission is a distinct treatment target from endoscopic remission in UC and better predicts clinical remission.
The current treatment target of UC is endoscopic remission with MES 0 as well as clinical remission, but distinguishing between MES 0 and MES 1 is difficult. In our previous study, we demonstrated that histologic activity predicts clinical relapse in UC patients with MES 0 or 1. However, there is no study on whether histologic remission can predict another target, such as endoscopic remission. The aim of this study was to evaluate whether histologic activity can predict the maintenance of endoscopic remission in UC patients with MES 0 or 1.

Aims & Methods

The aim of this study was to evaluate whether histologic activity can predict the maintenance of endoscopic remission in UC patients with Mayo endoscopic subscore (MES) 0 or 1. Four hundred ninety-two UC patients who underwent histologic evaluation at Samsung Medical Center from January 2018 to December 2020 were included in this study. Patients were divided into two groups based on their histologic activity: histologic remission and active. Endoscopic activity was assessed during follow-up, and the primary outcome was endoscopic remission according to histologic activity. Endoscopic remission was defined as an MES of 0, while histologic remission was defined as a Geboes score of < 3.1.

Results

Among the 492 patients, 435 were evaluated for endoscopic activity during the first colonoscopic follow-up, and 146 patients were evaluated during the second follow-up. The median time for the first follow-up colonoscopy was 27.3 months. The histologic active group at index colonoscopy was more likely to experience endoscopic relapse than the histologic remission group (hazard ratio (HR)= 1.63, P < 0.001). In subgroup analysis in patients without clinical relapse, the histologic active group was still more likely to experience endoscopic relapse than the histologic remission group (HR = 1.53, P = 0.030).

Conclusion

The patients who achieve histologic remission are more likely to maintain endoscopic remission compared to those with histologic activity.

References

1. Kaplan GG. The global burden of IBD: from 2015 to 2025. Nat Rev Gastroenterol Hepatol. 2015;12(12):720-7.
2. Magro F, Gionchetti P, Eliakim R, Ardizzone S, Armuzzi A, Barreiro-de Acosta M, et al. Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-intestinal Manifestations, Pregnancy, Cancer Surveillance, Surgery, and Ileo-anal Pouch Disorders. J Crohns Colitis. 2017;11(6):649-70.
3. Colombel JF, Narula N, Peyrin-Biroulet L. Management Strategies to Improve Outcomes of Patients With Inflammatory Bowel Diseases. Gastroenterology. 2017;152(2):351-61.e5.
4. Dassopoulos T, Cohen RD, Scherl EJ, Schwartz RM, Kosinski L, Regueiro MD. Ulcerative Colitis Care Pathway. Gastroenterology. 2015;149(1):238-45.
5. Peyrin-Biroulet L, Sandborn W, Sands BE, Reinisch W, Bemelman W, Bryant RV, et al. Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE): Determining Therapeutic Goals for Treat-to-Target. Am J Gastroenterol. 2015;110(9):1324-38.
6. Turner D, Ricciuto A, Lewis A, D'Amico F, Dhaliwal J, Griffiths AM, et al. STRIDE-II: An Update on the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) Initiative of the International Organization for the Study of IBD (IOIBD): Determining Therapeutic Goals for Treat-to-Target strategies in IBD. Gastroenterology. 2021;160(5):1570-83.

Conference

UEG Week Copenhagen 2023

Topics

IBD

Submission format

Abstract

Session

Crohn's disease or ulcerative colitis: To diagnose or not to diagnose? (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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PERIODONTITIS (PO) - A COMMON COMPLICATION OF CHRONIC INFLAMMATORY BOWEL DISEASE A SYMPTOM-ORIENTATED SCORE FOR RECORDING PO REQUIRING TREATMENT

Wolfgang Kreisel

UEG Presentation

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Measuring what matters: Pros and cons of therapeutic drug monitoring in IBD

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Measuring what matters: Pros and cons of therapeutic drug monitoring in IBD

Krisztina Barbara Gecse 1, Peter Bossuyt 2

Affiliations

1 Department of Gastroenterology and Hepatology, Amsterdam, Netherlands

2 Imelda General Hospital, Bonheiden, Belgium

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

Session

Precision in practice: The future of drug optimisation in IBD

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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PERIODONTITIS (PO) - A COMMON COMPLICATION OF CHRONIC INFLAMMATORY BOWEL DISEASE A SYMPTOM-ORIENTATED SCORE FOR RECORDING PO REQUIRING TREATMENT

Wolfgang Kreisel

UEG Presentation

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The immunomodulator’s shadow: Understanding lymphoma risk

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The immunomodulator’s shadow: Understanding lymphoma risk

Antonios Germanopoulos 1

Affiliations

1 University Hospital of Örebro, Örebro, Sweden

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

Topics

Immunology Mechanisms & Personalised Medicine IBD

Session

Thiopurines in IBD: Should I stay or should I go

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Measuring what matters: Pros and cons of therapeutic drug monitoring in IBD

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Peter Hegyi

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"The old enemy in new clothes“: Drugs

Esmeralda Capristo

PERIODONTITIS (PO) - A COMMON COMPLICATION OF CHRONIC INFLAMMATORY BOWEL DISEASE A SYMPTOM-ORIENTATED SCORE FOR RECORDING PO REQUIRING TREATMENT

Wolfgang Kreisel

UEG Presentation

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BEYOND RECURRENT ACUTE PANCREATITIS: EARLY CHRONIC PANCREATITIS AS A DISTINCT PHENOTYPE IN THE PANCREATITIS CONTINUUM

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BEYOND RECURRENT ACUTE PANCREATITIS: EARLY CHRONIC PANCREATITIS AS A DISTINCT PHENOTYPE IN THE PANCREATITIS CONTINUUM

Viktoria Venglovecz 1, Zsolt Abonyi Tóth 2, Vivien Vass 3, Petra Széplaki 2, Dalma Dobszai 3, Daniel Marino 4, Tamas Gonda 5, Zsófia Román 2, Balint Eross 2, Peter Jeno Hegyi 2, Áron Vincze 6, Ferenc Izbéki 7, Mária Papp 8, Alexandra Mikó 9, Katalin Márta 10, Andrea Szentesi 6, Peter Hegyi 11

Affiliations

1 University of Szeged, Szeged, Hungary

2 Centre for Translational Medicine, Semmelweis University, Budapest, Hungary, Budapest, Hungary

3 Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary

4 Division of Gastroenterology, New York University, New York, United States

5 Columbia University, New York, United States

6 University of Pécs, Pécs, Hungary

7 Saint George University Hospital, Szekesfehervar, Hungary

8 University of Debrecen, Debrecen, Hungary

9 University of Pécs, Medical School, Pécs, Hungary

10 Semmelweis University, Budapest, Hungary

11 Semmelweis University, Pecs, Hungary

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Abstract

Introduction

Recurrent episodes of acute pancreatitis (AP) are associated with an increased risk of chronic pancreatitis (CP). We previously proposed early chronic pancreatitis (ECP), defined as ≥3 AP episodes without radiological features of CP, as an intermediate stage within this continuum. This study aimed to determine whether ECP has a distinct clinical phenotype compared with recurrent acute pancreatitis (RAP) and established CP.

Aims & Methods

We conducted a post hoc analysis of prospectively collected data from the Hungarian Pancreatic Study Group AP Registry. A total of 1,717 patients enrolled between 2017 and 2025 were classified as AP (one episode; n=1,143), RAP (two episodes without CP morphology; n=215), ECP (≥3 episodes without CP morphology; n=152), or acute-on-chronic pancreatitis (ACP; AP with radiological features of CP; n=207). Demographic, etiological, lifestyle, clinical, and endoscopic characteristics were compared across disease stages.

Results

ECP displayed several characteristics that differed from RAP and approached those observed in ACP. The proportion of male patients increased from 58% in RAP to 72% in ECP and 79% in ACP. Alcohol-related etiology increased from 23% to 36% and 45%, respectively, while smoking prevalence increased from 36% in RAP to 49% in ECP and 68% in ACP. Endoscopic management also showed a distinct pattern across disease stages. Prophylactic pancreatic stenting predominated in AP (71%) and RAP (67%), whereas pancreatic duct-directed interventions accounted for 42% of procedures in ECP and became predominant in ACP (77%). Thus, despite the absence of radiological CP, ECP already demonstrated epidemiological, etiological, and endoscopic features resembling more established pancreatic disease.

Conclusion

ECP is clinically distinguishable from RAP and represents a distinct transitional phenotype within the pancreatitis continuum. Recognition of patients with ≥3 AP episodes may facilitate earlier risk-factor modification, specialist evaluation, and tailored management before established morphological CP develops. Funding: National Research, Development and Innovation Office (SNN152834) and the Albert Szent-Györgyi Research Grant of the Albert Szent-Györgyi Medical School, University of Szeged.

Event

UEG Week Barcelona 2026

Topics

Immunology Pancreas Mechanisms & Personalised Medicine Histopathology Hepatobiliary Digestive Oncology

Submission format

Late-Breaking Abstract

Session

Late-Breaking: Advances in liver and pancreatic disease

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Measuring what matters: Pros and cons of therapeutic drug monitoring in IBD

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PERIODONTITIS (PO) - A COMMON COMPLICATION OF CHRONIC INFLAMMATORY BOWEL DISEASE A SYMPTOM-ORIENTATED SCORE FOR RECORDING PO REQUIRING TREATMENT

Wolfgang Kreisel

UEG Presentation

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Therapy prediction: Does it make sense?

Ahmed Hegazy 1, Arthur Kaser 2

Affiliations

1 Charité – Universitätsmedizin Berlin, Berlin, Germany

2 University of Cambridge Gastroenterology and Hepatology, Cambridge, United Kingdom

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Abstract

Event

UEG Week Berlin 2025

Session

The art of making clinical research precise: Predicting therapy response in IBD

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Measuring what matters: Pros and cons of therapeutic drug monitoring in IBD

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The immunomodulator’s shadow: Understanding lymphoma risk

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Peter Hegyi

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"The old enemy in new clothes“: Drugs

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PERIODONTITIS (PO) - A COMMON COMPLICATION OF CHRONIC INFLAMMATORY BOWEL DISEASE A SYMPTOM-ORIENTATED SCORE FOR RECORDING PO REQUIRING TREATMENT

Wolfgang Kreisel

UEG Presentation

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"The old enemy in new clothes“: Drugs

Esmeralda Capristo 1

Affiliations

1 l'Università Cattolica del S, Cuore di Roma, Rome, Italy

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Abstract

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Endoscopy Surgery

Session

Is the surgical "era" coming to an end?

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

More Like This:

Measuring what matters: Pros and cons of therapeutic drug monitoring in IBD

Peter Bossuyt

The immunomodulator’s shadow: Understanding lymphoma risk

Antonios Germanopoulos

BEYOND RECURRENT ACUTE PANCREATITIS: EARLY CHRONIC PANCREATITIS AS A DISTINCT PHENOTYPE IN THE PANCREATITIS CONTINUUM

Peter Hegyi

Therapy prediction: Does it make sense?

Arthur Kaser

"The old enemy in new clothes“: Drugs

Esmeralda Capristo

PERIODONTITIS (PO) - A COMMON COMPLICATION OF CHRONIC INFLAMMATORY BOWEL DISEASE A SYMPTOM-ORIENTATED SCORE FOR RECORDING PO REQUIRING TREATMENT

Wolfgang Kreisel

UEG Poster

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PERIODONTITIS (PO) - A COMMON COMPLICATION OF CHRONIC INFLAMMATORY BOWEL DISEASE A SYMPTOM-ORIENTATED SCORE FOR RECORDING PO REQUIRING TREATMENT

Madline P. Gund 1, Matthias Hannig 1, Stefan Rupf 1, Wolfgang Kreisel 2

Affiliations

1 Saarland University Medical Centre, Homburg, Germany, Homburg, Germany

2 University of Freiburg, Faculty of Medicine, Medical Centre, Freiburg, Germany

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Abstract

Introduction

A disturbed intestinal mucosal barrier is crucial in the pathogenesis of chronic inflammatory bowel disease (IBD). A higher susceptibility of patients with IBD to periodontitis (PO) is consistent with a similar pathogenesis. However, PO is often neglected in IBD patients, because their therapy is focussed on the intestinal symptoms.

Aims & Methods

A symptom-orientated score should be developed, which results from the information in a questionnaire that patients answer. A threshold value should indicate PO requiring treatment. A PO score is calculated on the basis of the questionnaire and compared with an objective grading of PO (determined by a clinical assessment). Grade 0 = no PO, grade 1 = mild PO (not requiring treatment), grade 2 = moderate PO, grade 3 or 4 = severe PO. Data was collected from 146 control subjects without IBD, 76 patients with Crohn's disease (CD) and 42 patients with ulcerative colitis (UC).

Results

	Clinical grade of PO	Number	Percent	Mean PO score
Persons without IBD	0 1 2 3 4 total	23 2 36 64 31 146	15.8 1.4 24.7 43.8 14.4 100	9.1
UC	2 3 4 total	12 29 1 42	28.5 69.0 2.4 100	8.7
CD	2 3 4 total	23 46 7 76	30.3 60.5 9.2 100	9.7

The table shows the distribution of clinical PO grades in the 3 groups (No IBD, CD, CU) in absolute numbers and per cent as well as the respective mean PO score. The data of the control group were used for the evaluation of the questionnaire. There was a good correlation between the objective degree of PO and the PO score determined from the patients' statements. The ROC analysis showed that a PO score of 6.75 resulted in a sensitivity of 72.4% and a specificity of 64% for the detection of PO stage ≥ 2. For the detection of a PO stage ≥ 3, a PO score of 7.75 results in a sensitivity of 73.2% and a specificity of 64%. The AUROC was 0.746 and 0.742, respectively. There were no cases with grade 0 or 1 PO in the CD group or UC group, i.e. all had at least moderate/moderate PO. The high prevalence of severe PO, even in people without IBD, can be explained by the fact that most of these people were recruited in a specialised periodontology clinic. Accordingly, the mean PO score is relatively high here.

Conclusion

Our data confirm a high prevalence of higher grade PO requiring treatment in patients with IBD. A higher PO score (from 6.75) can predict with high probability PO requiring treatment, which is often overlooked or neglected in IBD patients. These patients can therefore be referred for integrated therapy.

References

Chang JT. Pathophysiology of Inflammatory Bowel Diseases. New England Journal of Medicine 2020; 383: 2652–2664
Saez A, Herrero-Fernandez B, Gomez-Bris R, Sánchez-Martinez H, Gonzalez-Granado JM. Pathophysiology of Inflammatory Bowel Disease: Innate Immune System. Int J Mol Sci 2023; 24: 1526.
Axelrad JE, Cadwell KH, Colombel J-F, Shah SC. The role of gastrointestinal pathogens in inflammatory bowel disease: a systematic review. Therap Adv Gastroenterol 2021; 14: 17562848211004493
Ananthakrishnan AN, Singal AG, Chang L. The Gut Microbiome and Digestive Health – A New Frontier. Clinical Gastroenterology and Hepatology 2019; 17: 215–217.
She Y-Y, Kong X-B, Ge Y-P, Liu Z-Y, Chen J-Y, Jiang J-W, Jiang H-B, Fang S-L. Periodontitis and inflammatory bowel disease: a meta-analysis. BMC Oral Health 2020; 20: 67.
Bertl K, Burisch J, Pandis N, Bruckmann C, Klinge B, Stavropoulos A. Periodontitis prevalence in patients with Ulcerative colitis and Crohn’s disease - PPCC: A case-control study. J Clin Periodontol 2022; 49: 1262–1274.

Conference

UEG Week Berlin 2025

Topics

IBD

Submission format

Abstract

Session

IBD (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

More Like This:

Measuring what matters: Pros and cons of therapeutic drug monitoring in IBD

Peter Bossuyt

The immunomodulator’s shadow: Understanding lymphoma risk

Antonios Germanopoulos

BEYOND RECURRENT ACUTE PANCREATITIS: EARLY CHRONIC PANCREATITIS AS A DISTINCT PHENOTYPE IN THE PANCREATITIS CONTINUUM

Peter Hegyi

Therapy prediction: Does it make sense?

Arthur Kaser

"The old enemy in new clothes“: Drugs

Esmeralda Capristo

PERIODONTITIS (PO) - A COMMON COMPLICATION OF CHRONIC INFLAMMATORY BOWEL DISEASE A SYMPTOM-ORIENTATED SCORE FOR RECORDING PO REQUIRING TREATMENT

Wolfgang Kreisel