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Healing of the epithelial barrier in the ileum is superior to endoscopic and histologic remission for predicting major adverse outcomes in ulcerative colitis

BACKGROUND: Achieving endoscopic remission is a key therapeutic goal in patients with ulcerative colitis (UC) that is associated with favorable long-term disease outcomes. Here, we prospectively compared the predictive value of endoscopic and/or histologic remission against ileal barrier healing for...

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Autores principales: Rath, Timo, Atreya, Raja, Bodenschatz, Julia, Uter, Wolfgang, Geppert, Carol I., Vitali, Francesco, Zundler, Sebastian, Waldner, Maximilian J., Hartmann, Arndt, Neurath, Markus F.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10595008/
https://www.ncbi.nlm.nih.gov/pubmed/37881628
http://dx.doi.org/10.3389/fmed.2023.1221449
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author Rath, Timo
Atreya, Raja
Bodenschatz, Julia
Uter, Wolfgang
Geppert, Carol I.
Vitali, Francesco
Zundler, Sebastian
Waldner, Maximilian J.
Hartmann, Arndt
Neurath, Markus F.
author_facet Rath, Timo
Atreya, Raja
Bodenschatz, Julia
Uter, Wolfgang
Geppert, Carol I.
Vitali, Francesco
Zundler, Sebastian
Waldner, Maximilian J.
Hartmann, Arndt
Neurath, Markus F.
author_sort Rath, Timo
collection PubMed
description BACKGROUND: Achieving endoscopic remission is a key therapeutic goal in patients with ulcerative colitis (UC) that is associated with favorable long-term disease outcomes. Here, we prospectively compared the predictive value of endoscopic and/or histologic remission against ileal barrier healing for predicting long-term disease behavior in a large cohort of UC patients in clinical remission. METHODS: At baseline, UC patients in clinical remission underwent ileocolonoscopy with assessment of ileal barrier function by confocal endomicroscopy. Endoscopic and histologic disease activity and ileal barrier healing were scored using validated scores. During subsequent follow-up (FU), patients were closely monitored for clinical disease activity and occurrence of major adverse outcomes (MAO) defined as the following: disease relapse; UC-related hospitalization; UC-related surgery; necessity for initiation or dose escalation of systemic steroids, immunosuppressants, small molecules or biological therapy. RESULTS: Of the 73 UC patients included, 67% experienced MAO during a mean FU of 25 months. The probability of MAO-free survival was significantly higher in UC patients with endoscopic and/or histologic remission compared to patients with endoscopically and/or histologically active disease. Ileal barrier healing on endomicroscopy was highly accurate for predicting the further course of UC and outcompeted endoscopic and histologic remission for predicting MAO-free survival. CONCLUSION: Ileal barrier healing in clinically remittent UC patients can accurately predict future MAO development and is superior in its predictive capabilities than endoscopic and histologic remission. Ileal barrier healing therefore represents a novel and superior surrogate parameter for stratification of UC patients according to their risk for development of complicated disease behavior. CLINICAL TRIAL REGISTRATION: https://classic.clinicaltrials.gov/ct2/show/NCT05157750, identifier NCT05157750.
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spelling pubmed-105950082023-10-25 Healing of the epithelial barrier in the ileum is superior to endoscopic and histologic remission for predicting major adverse outcomes in ulcerative colitis Rath, Timo Atreya, Raja Bodenschatz, Julia Uter, Wolfgang Geppert, Carol I. Vitali, Francesco Zundler, Sebastian Waldner, Maximilian J. Hartmann, Arndt Neurath, Markus F. Front Med (Lausanne) Medicine BACKGROUND: Achieving endoscopic remission is a key therapeutic goal in patients with ulcerative colitis (UC) that is associated with favorable long-term disease outcomes. Here, we prospectively compared the predictive value of endoscopic and/or histologic remission against ileal barrier healing for predicting long-term disease behavior in a large cohort of UC patients in clinical remission. METHODS: At baseline, UC patients in clinical remission underwent ileocolonoscopy with assessment of ileal barrier function by confocal endomicroscopy. Endoscopic and histologic disease activity and ileal barrier healing were scored using validated scores. During subsequent follow-up (FU), patients were closely monitored for clinical disease activity and occurrence of major adverse outcomes (MAO) defined as the following: disease relapse; UC-related hospitalization; UC-related surgery; necessity for initiation or dose escalation of systemic steroids, immunosuppressants, small molecules or biological therapy. RESULTS: Of the 73 UC patients included, 67% experienced MAO during a mean FU of 25 months. The probability of MAO-free survival was significantly higher in UC patients with endoscopic and/or histologic remission compared to patients with endoscopically and/or histologically active disease. Ileal barrier healing on endomicroscopy was highly accurate for predicting the further course of UC and outcompeted endoscopic and histologic remission for predicting MAO-free survival. CONCLUSION: Ileal barrier healing in clinically remittent UC patients can accurately predict future MAO development and is superior in its predictive capabilities than endoscopic and histologic remission. Ileal barrier healing therefore represents a novel and superior surrogate parameter for stratification of UC patients according to their risk for development of complicated disease behavior. CLINICAL TRIAL REGISTRATION: https://classic.clinicaltrials.gov/ct2/show/NCT05157750, identifier NCT05157750. Frontiers Media S.A. 2023-10-10 /pmc/articles/PMC10595008/ /pubmed/37881628 http://dx.doi.org/10.3389/fmed.2023.1221449 Text en Copyright © 2023 Rath, Atreya, Bodenschatz, Uter, Geppert, Vitali, Zundler, Waldner, Hartmann and Neurath. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
Rath, Timo
Atreya, Raja
Bodenschatz, Julia
Uter, Wolfgang
Geppert, Carol I.
Vitali, Francesco
Zundler, Sebastian
Waldner, Maximilian J.
Hartmann, Arndt
Neurath, Markus F.
Healing of the epithelial barrier in the ileum is superior to endoscopic and histologic remission for predicting major adverse outcomes in ulcerative colitis
title Healing of the epithelial barrier in the ileum is superior to endoscopic and histologic remission for predicting major adverse outcomes in ulcerative colitis
title_full Healing of the epithelial barrier in the ileum is superior to endoscopic and histologic remission for predicting major adverse outcomes in ulcerative colitis
title_fullStr Healing of the epithelial barrier in the ileum is superior to endoscopic and histologic remission for predicting major adverse outcomes in ulcerative colitis
title_full_unstemmed Healing of the epithelial barrier in the ileum is superior to endoscopic and histologic remission for predicting major adverse outcomes in ulcerative colitis
title_short Healing of the epithelial barrier in the ileum is superior to endoscopic and histologic remission for predicting major adverse outcomes in ulcerative colitis
title_sort healing of the epithelial barrier in the ileum is superior to endoscopic and histologic remission for predicting major adverse outcomes in ulcerative colitis
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10595008/
https://www.ncbi.nlm.nih.gov/pubmed/37881628
http://dx.doi.org/10.3389/fmed.2023.1221449
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