Simplified Histologic Mucosal Healing Scheme (SHMHS) for inflammatory bowel disease: a nationwide multicenter study of performance and applicability.
Endoscopic score
Histological assessment
Inflammatory bowel disease
Mucosal healing
Journal
Techniques in coloproctology
ISSN: 1128-045X
Titre abrégé: Tech Coloproctol
Pays: Italy
ID NLM: 9613614
Informations de publication
Date de publication:
09 2022
09 2022
Historique:
received:
22
01
2022
accepted:
24
04
2022
pubmed:
2
6
2022
medline:
11
8
2022
entrez:
1
6
2022
Statut:
ppublish
Résumé
Assessment of mucosal healing is important for the management of patients with inflammatory bowel disease (IBD), but endoscopy can miss microscopic disease areas that may relapse. Histological assessment is informative, but no single scoring system is widely adopted. We previously proposed an eight-item histological scheme for the easy, fast reporting of disease activity in the intestine. The aim of the present study was to evaluate the performance of our Simplified Histologic Mucosal Healing Scheme (SHMHS). Between April and May 2021 pathologists and gastroenterologists in Italy were invited to contribute to this multicenter study by providing data on single endoscopic-histological examinations for their IBD patients undergoing treatment. Disease activity was expressed using SHMHS (maximum score, 8) and either Simple Endoscopic Score for Crohn's Disease (categorized into grades 0-3) or Mayo Endoscopic Subscore (range 0-3). Thirty hospitals provided data on 597 patients (291 Crohn's disease; 306 ulcerative colitis). The mean SHMHS score was 2.96 (SD = 2.42) and 66.8% of cases had active disease (score ≥ 2). The mean endoscopic score was 1.23 (SD = 1.05), with 67.8% having active disease (score ≥ 1). Histologic and endoscopic scores correlated (Spearman's ρ = 0.76), and scores for individual SHMHS items associated directly with endoscopic scores (chi-square p < 0.001, all comparisons). Between IBD types, scores for SHMHS items reflected differences in presentation, with cryptitis more common and erosions/ulcerations less common in Crohn's disease, and the distal colon more affected in ulcerative colitis. SHMHS captures the main histological features of IBD. Routine adoption may simplify pathologist workload while ensuring accurate reporting for clinical decision making.
Sections du résumé
BACKGROUND
Assessment of mucosal healing is important for the management of patients with inflammatory bowel disease (IBD), but endoscopy can miss microscopic disease areas that may relapse. Histological assessment is informative, but no single scoring system is widely adopted. We previously proposed an eight-item histological scheme for the easy, fast reporting of disease activity in the intestine. The aim of the present study was to evaluate the performance of our Simplified Histologic Mucosal Healing Scheme (SHMHS).
METHODS
Between April and May 2021 pathologists and gastroenterologists in Italy were invited to contribute to this multicenter study by providing data on single endoscopic-histological examinations for their IBD patients undergoing treatment. Disease activity was expressed using SHMHS (maximum score, 8) and either Simple Endoscopic Score for Crohn's Disease (categorized into grades 0-3) or Mayo Endoscopic Subscore (range 0-3).
RESULTS
Thirty hospitals provided data on 597 patients (291 Crohn's disease; 306 ulcerative colitis). The mean SHMHS score was 2.96 (SD = 2.42) and 66.8% of cases had active disease (score ≥ 2). The mean endoscopic score was 1.23 (SD = 1.05), with 67.8% having active disease (score ≥ 1). Histologic and endoscopic scores correlated (Spearman's ρ = 0.76), and scores for individual SHMHS items associated directly with endoscopic scores (chi-square p < 0.001, all comparisons). Between IBD types, scores for SHMHS items reflected differences in presentation, with cryptitis more common and erosions/ulcerations less common in Crohn's disease, and the distal colon more affected in ulcerative colitis.
CONCLUSIONS
SHMHS captures the main histological features of IBD. Routine adoption may simplify pathologist workload while ensuring accurate reporting for clinical decision making.
Identifiants
pubmed: 35648263
doi: 10.1007/s10151-022-02628-7
pii: 10.1007/s10151-022-02628-7
pmc: PMC9360061
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
713-723Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2022. The Author(s).
Références
Bryant RV, Winer S, Travis SP, Riddell RH (2014) Systematic review: histological remission in inflammatory bowel disease. Is ‘complete’ remission the new treatment paradigm? An IOIBD initiative. J Crohn’s Colitis 8:1582–1597. https://doi.org/10.1016/j.crohns.2014.08.011
doi: 10.1016/j.crohns.2014.08.011
Bitton A, Peppercorn MA, Antonioli DA et al (2001) Clinical, biological, and histologic parameters as predictors of relapse in ulcerative colitis. Gastroenterology 120:13–20. https://doi.org/10.1053/gast.2001.20912
doi: 10.1053/gast.2001.20912
pubmed: 11208709
Pennelli G, Grillo F, Galuppini F et al (2020) Gastritis: update on etiological features and histological practical approach. Pathologica 112:153–165. https://doi.org/10.32074/1591-951X-163
doi: 10.32074/1591-951X-163
pubmed: 33179619
pmcid: 7931571
Mosli MH, Feagan BG, Zou G et al (2017) Development and validation of a histological index for UC. Gut 66:50–58. https://doi.org/10.1136/gutjnl-2015-310393
doi: 10.1136/gutjnl-2015-310393
pubmed: 26475633
Mazzuoli S, Guglielmi FW, Antonelli E et al (2013) Definition and evaluation of mucosal healing in clinical practice. Dig Liver Dis 45:969–977. https://doi.org/10.1016/j.dld.2013.06.010
doi: 10.1016/j.dld.2013.06.010
pubmed: 23932331
Mosli MH, Feagan BG, Zou G et al (2015) Reproducibility of histological assessments of disease activity in UC. Gut 64:1765–1773. https://doi.org/10.1136/gutjnl-2014-307536
doi: 10.1136/gutjnl-2014-307536
pubmed: 25360036
Langner C, Magro F, Driessen A et al (2014) The histopathological approach to inflammatory bowel disease: a practice guide. Virchows Arch 464:511–527. https://doi.org/10.1007/s00428-014-1543-4
pubmed: 24487791
Lang-Schwarz C, Agaimy A, Atreya R et al (2021) Maximizing the diagnostic information from biopsies in chronic inflammatory bowel diseases: recommendations from the Erlangen International Consensus Conference on Inflammatory Bowel Diseases and presentation of the IBD-DCA score as a proposal for a new i. Virchows Arch 478:581–594. https://doi.org/10.1007/s00428-020-02982-7
doi: 10.1007/s00428-020-02982-7
pubmed: 33373023
Marchal-Bressenot A, Salleron J, Boulagnon-Rombi C et al (2017) Development and validation of the Nancy histological index for UC. Gut 66:43–49. https://doi.org/10.1136/GUTJNL-2015-310187
doi: 10.1136/gutjnl-2015-310187
pubmed: 26464414
Villanacci V, Antonelli E, Geboes K et al (2013) Histological healing in inflammatory bowel disease: a still unfulfilled promise. World J Gastroenterol 19:968. https://doi.org/10.3748/wjg.v19.i7.968
doi: 10.3748/wjg.v19.i7.968
pubmed: 23467585
pmcid: 3582008
Magro F, Langner C, Driessen A et al (2013) European consensus on the histopathology of inflammatory bowel disease. J Crohn’s Colitis 7:827–851. https://doi.org/10.1016/j.crohns.2013.06.001
doi: 10.1016/j.crohns.2013.06.001
Stange EF, Travis SPL, Vermeire S et al (2008) European evidence-based consensus on the diagnosis and management of ulcerative colitis: definitions and diagnosis. J Crohn’s Colitis 2:1–23. https://doi.org/10.1016/j.crohns.2007.11.001
doi: 10.1016/j.crohns.2007.11.001
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. https://doi.org/10.1038/ajg.2012.301
doi: 10.1038/ajg.2012.301
pubmed: 23147523
Pai RK, Geboes K (2018) Disease activity and mucosal healing in inflammatory bowel disease: a new role for histopathology? Virchows Arch 472:99–110. https://doi.org/10.1007/s00428-017-2156-5
doi: 10.1007/s00428-017-2156-5
pubmed: 28555281
Farkas K, Reisz Z, Sejben A et al (2016) Histological activity and basal plasmacytosis are nonpredictive markers for subsequent relapse in ulcerative colitis patients with mucosal healing. J Gastroenterol Pancreatol Liver Disord 3:01–04. https://doi.org/10.15226/2374-815X/3/4/00163
doi: 10.15226/2374-815X/3/4/00163
Vande Casteele N, Leighton JA, Pasha SF et al (2021) Utilizing deep learning to analyze whole slide images of colonic biopsies for associations between eosinophil density and clinicopathologic features in active ulcerative colitis. Inflamm Bowel Dis. https://doi.org/10.1093/ibd/izab122
pubmed: 33051647
Reggiani Bonetti L, Leoncini G, Daperno M et al (2021) Histopathology of non-IBD colitis practical recommendations from pathologists of IG-IBD Group. Dig Liver Dis 53:950–957. https://doi.org/10.1016/J.DLD.2021.01.026
doi: 10.1016/j.dld.2021.01.026
pubmed: 33712395
Villanacci V, Antonelli E, Lanzarotto F et al (2017) Usefulness of different pathological scores to assess healing of the mucosa in inflammatory bowel diseases: a real life study. Sci Rep 7:6839. https://doi.org/10.1038/s41598-017-07338-x
doi: 10.1038/s41598-017-07338-x
pubmed: 28754920
pmcid: 5533718
Schroeder KW, Tremaine WJ, Ilstrup DM (1987) Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. N Engl J Med 317:1625–1629. https://doi.org/10.1056/NEJM198712243172603
doi: 10.1056/NEJM198712243172603
pubmed: 3317057
Daperno M, D’Haens G, Van Assche G et al (2004) Development and validation of a new, simplified endoscopic activity score for Crohn’s disease: the SES-CD. Gastrointest Endosc 60:505–512. https://doi.org/10.1016/S0016-5107(04)01878-4
doi: 10.1016/S0016-5107(04)01878-4
pubmed: 15472670
R Core Team R: A language and environment for statistical computing
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. https://doi.org/10.1136/GUTJNL-2015-309598
doi: 10.1136/gutjnl-2015-309598
pubmed: 25986946
Villanacci V, Antonelli E, Reboldi G et al (2014) Endoscopic biopsy samples of naïve “colitides” patients: role of basal plasmacytosis. J Crohns Colitis 8:1438–1443. https://doi.org/10.1016/J.CROHNS.2014.05.003
doi: 10.1016/j.crohns.2014.05.003
pubmed: 24931895
Rosenberg L, Nanda KS, Zenlea T et al (2013) Histologic markers of inflammation in patients with ulcerative colitis in clinical remission. Clin Gastroenterol Hepatol 11:991–996. https://doi.org/10.1016/j.cgh.2013.02.030
doi: 10.1016/j.cgh.2013.02.030
pubmed: 23591275
pmcid: 3753658
Fiorino G, Cesarini M, Indriolo A, Malesci A (2011) Mucosal healing in ulcerative colitis: where do we stand? Curr Drug Targets 12:1417–1423. https://doi.org/10.2174/138945011796818216
doi: 10.2174/138945011796818216
pubmed: 21466490