The emerging role of histologic disease activity assessment in ulcerative colitis Rish K. Pai, MD, PhD, Vipul Jairath, MD, PhD, Niels Vande Casteele,

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Presentation transcript:

The emerging role of histologic disease activity assessment in ulcerative colitis Rish K. Pai, MD, PhD, Vipul Jairath, MD, PhD, Niels Vande Casteele, PharmD, PhD, Florian Rieder, MD, Claire E. Parker, MLIA, MA, Gregory Y. Lauwers, MD Gastrointestinal Endoscopy Volume 88, Issue 6, Pages 887-898 (December 2018) DOI: 10.1016/j.gie.2018.08.018 Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 1 Endoscopic measurements of disease activity in UC. A, Normal endoscopic appearance (MES = 0). B, Mild endoscopic disease characterized by erythema and loss of vascular pattern (MES = 1). C, Moderate disease with friability and erosions (MES = 2). D, Severe endoscopic disease with spontaneous bleeding and ulceration (MES = 3). Gastrointestinal Endoscopy 2018 88, 887-898DOI: (10.1016/j.gie.2018.08.018) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 2 Endoscopic and histologic findings from a patient in clinical remission. A, Colonoscopy demonstrated unremarkable colonic mucosa (MES = 0). B, A colonic biopsy demonstrated active disease characterized by neutrophilic cryptitis (arrow). Gastrointestinal Endoscopy 2018 88, 887-898DOI: (10.1016/j.gie.2018.08.018) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 3 Spectrum of histologic disease seen in ulcerative colitis. A, Representative biopsy from a patient with active ulcerative colitis. This biopsy fragment demonstrates crypt architectural distortion, neutrophil-mediated epithelial injury (cryptitis and crypt abscesses), and basal plasmacytosis (characterized by dense plasma cells separating colonic crypts from the muscularis mucosae). B, Severe histologic activity with ulceration characterized by granulation tissue with associated neutrophilic inflammation. C, A biopsy demonstrating chronic active colitis without basal plasmacytosis. There is crypt atrophy and scattered foci of neutrophilic cryptitis (arrows). D, A colonic biopsy fragment with increased lamina propria eosinophils. Gastrointestinal Endoscopy 2018 88, 887-898DOI: (10.1016/j.gie.2018.08.018) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 4 Proposed histologic targets in ulcerative colitis. A, Histologic normalization. B, Histologic quiescence without basal plasmacytosis or increased lamina propria eosinophils. C, Histologic quiescence with basal plasmacytosis. D, Histologic near remission characterized by rare neutrophilic crypts (arrow) and absence of basal plasmacytosis. Gastrointestinal Endoscopy 2018 88, 887-898DOI: (10.1016/j.gie.2018.08.018) Copyright © 2018 American Society for Gastrointestinal Endoscopy Terms and Conditions