Original Article
Alimentary Tract
Histologic Features of Colon Biopsies (Geboes Score) Associated With Progression of Ulcerative Colitis for the First 36 Months After Biopsy

https://doi.org/10.1016/j.cgh.2020.09.017Get rights and content

Background & Aims

In addition to findings from endoscopy, histologic features of colon biopsies have been associated with outcomes of patients with ulcerative colitis (UC). We investigated associations between Geboes scores (a system to quantify structural changes and inflammatory activity in colon biopsies) and UC progression, and the time period over which this association is valid.

Methods

We analyzed data from 399 asymptomatic patients with UC enrolled in the ACERTIVE study, followed at 13 inflammatory bowel disease (IBD) centers in Portugal through 31 December 2019. Blood and stool samples were collected and analyzed, and all patients underwent sigmoidoscopy within 24 h of sample collection. We assessed baseline endoscopic status (Mayo endoscopic subscore), histologic features of 2 sigmoid and 2 rectal biopsies (Geboes score), and concentration of fecal calprotectin (FC). The primary outcome was UC progression (surgical, pharmacologic, and clinical events). We generated survival curves for 36 months or less and more than 36 months after biopsy according to Geboes score using the Kaplan-Meier method and compared findings with those from a log rank test. Cox regression was adjusted for Mayo endoscopic subscore, Geboes score, and level of FC; results were expressed as adjusted hazard ratios (HR) with 95% CIs.

Results

Patients with Geboes scores >2B.0, Geboes scores >3.0, or Geboes scores >4.0 had a higher frequency of, and a shorter time to UC progression, than patients with Geboes scores ≤2B.0, Geboes scores ≤3.0, or Geboes score ≤4.0 (P < .001). Disease progression occurred earlier in patients with Geboes scores >2B.0, Geboes scores >3.0, or Geboes scores >4.0 compared with patients with Geboes scores ≤2B.0 (HR, 2.021; 95% CI, 1.158–3.526), Geboes scores ≤3.0 (HR, 2.007; 95% CI, 1.139–3.534), or Geboes scores ≤4.0 (HR, 2.349; 95% CI, 1.269–4.349), respectively, in the first 36 months after biopsy. Similar results were found for patients with concentrations of FC below 150 μg/g.

Conclusions

We found histologic features of colon biopsies (Geboes score) to be an independent risk factor for progression of UC in the first 36 months after biopsy.

Section snippets

Study Design and Participants

This study was based on a convenience sample of asymptomatic UC patients who were previously enrolled in the prospective study ACERTIVE.19 All patients signed an informed consent form before their inclusion in the study.19

Patients were followed in 13 inflammatory bowel disease centers in Portugal until December 31, 2019. Patients were prospectively followed during the study period, without establishing fixed periods for the follow-up.

Patients who met the following criteria were included: older

Demographic and Clinical Characteristics

The description of the cohort of UC patients is presented in Table 1. This cohort consisted of 399 asymptomatic patients with a median age of 53 years (44–65), and 53% were female.

Progressive disease occurred in 31% of patients during the study period. The prescription or use of at least one course of oral corticosteroids (14%), de novo azathioprine (10%), de novo anti-TNFα (9%), and increase in the dose of azathioprine or biologics (9%) were the most frequent events of the composite outcome.

Discussion

In this study we have shown that histologic activity (GS >2B.0, GS >3.0, or GS>4.0) is an independent risk factor for the occurrence of progressive disease in asymptomatic UC patients in the first 36 months from biopsy but not after this period, suggesting that the value of histologic assessment is time-limited. Most of the published studies have determined the cutoff values of histologic activity that are associated with worse outcomes in UC patients.6,10,12,21 In this study, besides showing

Acknowledgments

The authors thank GEDII and all investigators at the hospitals who provided data for the study and Sandra Dias for all her assistance during data collection. MS acknowledges “Fundação para a Ciência e Tecnologia (FCT)”, Portugal under grant number PD/BD/142890/2018.

CRediT Authorship Contributions

Fernando Magro, MD, PhD (Conceptualization: Lead; Funding acquisition: Lead; Investigation: Supporting; Methodology: Equal; Validation: Lead; Writing – review & editing: Lead)

Catarina Alves (Data curation: Lead; Investigation: Lead;

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    Conflicts of interest This author discloses the following: FM received a fee for presenting from AbbVie, Ferring, Falk, Hospira, PharmaKern, MSD, Schering, Laboratórios Vitoria, Vifor Pharma, and OM Pharma. The remaining authors disclose no conflicts.

    Funding Supported by the Portuguese Group of Studies in Inflammatory Bowel Disease (GEDII).

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    Authors share co-first authorship.

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