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DO ALL PATIENTS IN ENDOSCOPIC REMISSION NEED BIOPSIES? SERUM IL-10 AS A BLOOD-BASED MARKER OF DEEP REMISSION IN ULCERATIVE COLITIS

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DO ALL PATIENTS IN ENDOSCOPIC REMISSION NEED BIOPSIES? SERUM IL-10 AS A BLOOD-BASED MARKER OF DEEP REMISSION IN ULCERATIVE COLITIS

Nikolaos Martinos 1, Andreas C. Lazaris 2, Christos Karakoidas 1, GEORGIOS KRANIDIOTIS 1, Constantinos Vasileiadis 1, Spyridon Sgouros 1, Christos Kroupis 2, Georgia-Eleni Thomopoulou 2

Affiliations

1 Naval Hospital of Athens, Athens, Greece

2 National and Kapodistrian University of Athens, Athens, Greece

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Abstract

Introduction

Endoscopic remission is a key therapeutic target in ulcerative colitis (UC), yet it does not reliably exclude persistent microscopic inflammation. Histologic confirmation therefore still requires mucosal biopsies, despite their invasive nature and limited practicality for repeated monitoring. A blood-based biomarker capable of identifying patients likely to have achieved both endoscopic and histologic healing could help refine the need for histologic assessment.

Aims & Methods

We aimed to determine whether serum IL-10 could identify deep remission in ulcerative colitis (UC) and help distinguish patients with persistent microscopic inflammation despite apparent endoscopic healing. In this prospective, single-centre observational study, consecutive adults with UC undergoing clinically indicated colonoscopy were enrolled. Serum IL-10 was measured by ELISA concurrently with endoscopic and histologic assessment. Endoscopic remission was defined as a Mayo Endoscopic Score (MES) ≤1 and histologic healing as a Geboes score <2.0; deep remission required both endpoints. Diagnostic performance was evaluated using receiver operating characteristic analysis with bootstrap internal validation, while multivariable Firth penalized logistic regression assessed the independent association between IL-10 and deep remission after adjustment for clinically relevant covariates and C-reactive protein. A prespecified analysis examined residual histologic inflammation among patients already in endoscopic remission.

Results

Among 137 patients with UC, 68 (49.6%) achieved deep remission. Endoscopic remission was observed in 99 patients; however, 31/99 (31.3%) retained microscopic inflammation despite apparent endoscopic healing. Within this subgroup, serum IL-10 concentrations were significantly higher in patients with histologic healing than in those with residual histologic inflammation (P<0.001). Serum IL-10 demonstrated excellent discrimination for deep remission, with an AUC of 0.947 (95% CI 0.905–0.982). An optimal threshold of 4.3 pg/mL yielded 91.2% sensitivity, 94.2% specificity, 93.8% positive predictive value, 91.8% negative predictive value, and 92.7% overall accuracy. In multivariable Firth penalized logistic regression, higher IL-10 remained independently associated with deep remission after adjustment for age, sex, disease duration, disease extent, treatment category, and CRP (adjusted OR 32.67, 95% CI 10.73–99.44; P<0.001), whereas CRP was not independently associated with deep remission (adjusted OR 0.74, 95% CI 0.45–1.23; P=0.243).

Table. Clinical Take-Home: Can Blood-Based IL-10 Refine the Need for Histologic Assessment?

Clinical question	Finding
How often does endoscopic remission conceal microscopic inflammation?	31/99 (31.3%)
Can serum IL-10 distinguish histologic healing from residual inflammation despite endoscopic remission?	Yes (P<0.001)
How accurately does IL-10 identify deep remission?	AUC 0.947 (95% CI 0.905–0.982)
What IL-10 threshold performed best for deep remission?	4.3 pg/mL
What was its diagnostic performance?	91.2% sensitivity; 94.2% specificity
Does IL-10 provide information beyond CRP?	OR 32.67 (95% CI 10.73–99.44); P<0.001

Conclusion

Nearly one-third of patients with UC in endoscopic remission retained microscopic inflammation, highlighting that endoscopic healing alone may not reliably indicate complete disease control. Serum IL-10 demonstrated excellent discrimination for deep remission and remained independently associated with this stringent endpoint beyond CRP. These findings support IL-10 as a promising blood-based biomarker to refine the selection of patients who may benefit most from histologic confirmation, potentially enabling a more individualized approach to biopsy-based monitoring in UC.

References

1. Turner D, Ricciuto A, Lewis A, et al. STRIDE-II: An update on the Selecting Therapeutic Targets in
Inflammatory Bowel Disease (STRIDE) initiative of the IOIBD. Gastroenterology.2021;160(5):1570-1583.e7.
2. Peyrin-Biroulet L, Sandborn W, Sands BE, et al. Selecting therapeutic targets in inflammatory bowel
disease (STRIDE): determining therapeutic goals for treat-to-target. Am J Gastroenterol.2015;110(9):1324-1338.
3.Martinos N., Lazaris A.C., Kroupis C., et al. Interleukin Signatures as Prognostic Biomarkers in Ulcerative
Colitis: From Immune Pathways to Clinical Prediction. Curr. Issues Mol. Biol. 2026, 48, 140.

Event

UEG Week Barcelona 2026

Topics

Histopathology Surgery Radiology & Imaging Mechanisms & Personalised Medicine Immunology IBD

Submission format

Late-Breaking Abstract

Session

Late-Breaking in IBD: From translational discoveries to treatment

Citation

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

Published

2026

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