Histopathological Assessment of the Microscopic Activity in Inflammatory Bowel Diseases: What Are We Looking For?

Overview

Journal World J Gastroenterol

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2022 Oct 3

PMID 36185628

Authors

Ondrej Fabian

Lukas Bajer

Affiliations

Soon will be listed here.

Abstract

Advances in diagnostics of inflammatory bowel diseases (IBD) and improved treatment strategies allowed the establishment of new therapeutic endpoints. Currently, it is desirable not only to cease clinical symptoms, but mainly to achieve endoscopic remission, a macroscopic normalization of the bowel mucosa. However, up to one-third of IBD patients in remission exhibit persisting microscopic activity of the disease. The evidence suggests a better predictive value of histology for the development of clinical complications such as clinical relapse, surgical intervention, need for therapy escalation, or development of colorectal cancer. The proper assessment of microscopic inflammatory activity thus became an important part of the overall histopathological evaluation of colonic biopsies and many histopathological scoring indices have been established. Nonetheless, a majority of them have not been validated and no scoring index became a part of the routine bioptic practice. This review summarizes a predictive value of microscopic disease activity assessment for the subsequent clinical course of IBD, describes the most commonly used scoring indices for Crohn's disease and ulcerative colitis, and comments on current limitations and unresolved issues.

Citing Articles

Enhancement of Cognitive Function by Andrographolide-Loaded Lactose β-Cyclodextrin Nanoparticles: Synthesis, Optimization, and Behavioural Assessment.

Paramanick D, Rani K, Singh V, Basist P, Khan R, Al-Tamimi J Pharmaceuticals (Basel). 2024; 17(7).

PMID: 39065814 PMC: 11279429. DOI: 10.3390/ph17070966.

Immunohistochemistry and real-time Polymerase Chain Reaction: importance in the diagnosis of intestinal tuberculosis in a Peruvian population.

Arevalo F, Rayme S, Ramirez R, Rolando R, Fustamante J, Monteghirfo M BMC Gastroenterol. 2024; 24(1):166.

PMID: 38755577 PMC: 11097500. DOI: 10.1186/s12876-024-03235-6.

Immunoglobulin G4-Related Disease of the Intestine: A Clinicopathological Entity to Be Considered.

Vernia F, Cirella L, Calvisi G, Viscido A, Latella G Medicina (Kaunas). 2024; 60(1).

PMID: 38256319 PMC: 10818347. DOI: 10.3390/medicina60010057.

Transient gestational hypothyroxinemia accelerates and enhances ulcerative colitis-like disorder in the male offspring.

Rivera J, Opazo M, Hernandez-Armengol R, Alvarez O, Mendoza-Leon M, Caamano E Front Endocrinol (Lausanne). 2024; 14:1269121.

PMID: 38239991 PMC: 10794346. DOI: 10.3389/fendo.2023.1269121.

Evaluation of Disease Activity in Inflammatory Bowel Disease: Diagnostic Tools in the Assessment of Histological Healing.

Jucan A, Gavrilescu O, Dranga M, Popa I, Mihai I, Mihai V Biomedicines. 2023; 11(11).

PMID: 38002090 PMC: 10669373. DOI: 10.3390/biomedicines11113090.

References

Azad S, Sood N, Sood A . Biological and histological parameters as predictors of relapse in ulcerative colitis: a prospective study. Saudi J Gastroenterol. 2011; 17(3):194-8. PMC: 3122090. DOI: 10.4103/1319-3767.80383. View

Johnson C, Hartman D, Ramos-Rivers C, Rao B, Bhattacharya A, Regueiro M . Epithelioid Granulomas Associate With Increased Severity and Progression of Crohn's Disease, Based on 6-Year Follow-Up. Clin Gastroenterol Hepatol. 2017; 16(6):900-907.e1. DOI: 10.1016/j.cgh.2017.12.034. View

Schaeffer D, Walsh J, Kirsch R, Waterman M, Silverberg M, Riddell R . Distinctive histopathologic phenotype in resection specimens from patients with Crohn's disease receiving anti-TNF-α therapy. Hum Pathol. 2014; 45(9):1928-35. DOI: 10.1016/j.humpath.2014.05.016. View

Christensen B, Hanauer S, Erlich J, Kassim O, Gibson P, Turner J . Histologic Normalization Occurs in Ulcerative Colitis and Is Associated With Improved Clinical Outcomes. Clin Gastroenterol Hepatol. 2017; 15(10):1557-1564.e1. PMC: 5618439. DOI: 10.1016/j.cgh.2017.02.016. View

Molander P, Sipponen T, Kemppainen H, Jussila A, Blomster T, Koskela R . Achievement of deep remission during scheduled maintenance therapy with TNFα-blocking agents in IBD. J Crohns Colitis. 2012; 7(9):730-5. DOI: 10.1016/j.crohns.2012.10.018. View

Almradi A, Ma C, DHaens G, Sandborn W, Parker C, Guizzetti L . An expert consensus to standardise the assessment of histological disease activity in Crohn's disease clinical trials. Aliment Pharmacol Ther. 2021; 53(7):784-793. DOI: 10.1111/apt.16248. View

Hefti M, Chessin D, Harpaz N, Steinhagen R, Ullman T . Severity of inflammation as a predictor of colectomy in patients with chronic ulcerative colitis. Dis Colon Rectum. 2009; 52(2):193-7. PMC: 2753491. DOI: 10.1007/DCR.0b013e31819ad456. View

PASCAL R, Gramlich T, Parker K, Gansler T . Geographic variations in eosinophil concentration in normal colonic mucosa. Mod Pathol. 1997; 10(4):363-5. View

Chateau T, Feakins R, Marchal-Bressenot A, Magro F, Danese S, Peyrin-Biroulet L . Histological Remission in Ulcerative Colitis: Under the Microscope Is the Cure. Am J Gastroenterol. 2019; 115(2):179-189. DOI: 10.14309/ajg.0000000000000437. View

10.

Rutter M, Saunders B, Wilkinson K, Rumbles S, Schofield G, Kamm M . Severity of inflammation is a risk factor for colorectal neoplasia in ulcerative colitis. Gastroenterology. 2004; 126(2):451-9. DOI: 10.1053/j.gastro.2003.11.010. View

11.

Mosli M, Feagan B, Zou G, Sandborn W, DHaens G, Khanna R . Development and validation of a histological index for UC. Gut. 2015; 66(1):50-58. DOI: 10.1136/gutjnl-2015-310393. View

12.

Fabian O, Hradsky O, Lerchova T, Mikus F, Zamecnik J, Bronsky J . Limited clinical significance of tissue calprotectin levels in bowel mucosa for the prediction of complicated course of the disease in children with ulcerative colitis. Pathol Res Pract. 2019; 215(12):152689. DOI: 10.1016/j.prp.2019.152689. View

13.

Pariente B, Mary J, Danese S, Chowers Y, De Cruz P, DHaens G . Development of the Lémann index to assess digestive tract damage in patients with Crohn's disease. Gastroenterology. 2014; 148(1):52-63.e3. DOI: 10.1053/j.gastro.2014.09.015. View

14.

Christensen B, Erlich J, Gibson P, Turner J, Hart J, Rubin D . Histologic Healing Is More Strongly Associated with Clinical Outcomes in Ileal Crohn's Disease than Endoscopic Healing. Clin Gastroenterol Hepatol. 2019; 18(11):2518-2525.e1. PMC: 7586726. DOI: 10.1016/j.cgh.2019.11.056. View

15.

Travis S, Higgins P, Orchard T, van der Woude C, Panaccione R, Bitton A . Review article: defining remission in ulcerative colitis. Aliment Pharmacol Ther. 2011; 34(2):113-24. DOI: 10.1111/j.1365-2036.2011.04701.x. View

16.

Pai R, Hartman D, Leighton J, Pasha S, Rivers C, Regueiro M . Validated Indices for Histopathologic Activity Predict Development of Colorectal Neoplasia in Ulcerative Colitis. J Crohns Colitis. 2021; 15(9):1481-1490. DOI: 10.1093/ecco-jcc/jjab042. View

17.

Villanacci V, Antonelli E, Reboldi G, Salemme M, Casella G, Bassotti G . Endoscopic biopsy samples of naïve "colitides" patients: role of basal plasmacytosis. J Crohns Colitis. 2014; 8(11):1438-43. DOI: 10.1016/j.crohns.2014.05.003. View

18.

Marchal-Bressenot A, Salleron J, Boulagnon-Rombi C, Bastien C, Cahn V, Cadiot G . Development and validation of the Nancy histological index for UC. Gut. 2015; 66(1):43-49. DOI: 10.1136/gutjnl-2015-310187. View

19.

Matsushita T, Maruyama R, Ishikawa N, Harada Y, Araki A, Chen D . The number and distribution of eosinophils in the adult human gastrointestinal tract: a study and comparison of racial and environmental factors. Am J Surg Pathol. 2015; 39(4):521-7. DOI: 10.1097/PAS.0000000000000370. View

20.

MATTS S . The value of rectal biopsy in the diagnosis of ulcerative colitis. Q J Med. 1961; 30:393-407. View