Correlation of Clinical, Endoscopic and Histopathological Activity in Ulcerative Colitis: A Cross-sectional Analysis EC01-EC05
Dr. Janaky Ramakrishnan,
Assistant Professor, Department of Pathology, KMCT Medical College, Mukkam, Calicut-673602, Kerala, India.
Introduction: There are several scoring systems in use to determine the endoscopic, clinical and histopathological activity in Ulcerative Colitis (UC) which helps in defining the optimal management strategy.
Aim: To understand the correlation between histological activity with simplified Geboes Score (GS), and clinical activity with Truelove and Witts Score (TLWS) and endoscopic activity with Mayo Endoscopic Score (MES) in UC. The study is also aimed at describing the common histopathological features of UC.
Materials and Methods: A cross-sectional analysis was conducted at a tertiary care hospital in Southern India for 1.5 years (November 2014 to May 2016). Consecutive colonoscopy biopsies of patients who presented with lower gastrointestinal symptoms and endoscopic findings suggestive of UC were included. Baseline characteristics including age, gender, symptoms, clinical signs and extent of disease were recorded. Disease severity was graded using TLWS, MES using endoscopy and GS. Spearman’s correlations between the MES, GS and TLWS were calculated.
Results: Sixty-two cases of clinically diagnosed UC patients were evaluated based on endoscopy and histopathology findings. The mean age was 44.7 years and 42 (67.74%) were males in the study. Proctosigmoiditis was the most common extent (32.25%), followed by cases of proctitis (25.80%), pancolitis (22.58%), and left sided colitis (14.51%). There was a strong correlation between MES/TLWS with a rho=0.614 (p<0.001), followed by MES/GS with rho=0.421 (p<0.001) and GS/MES with a rho=0.375 (p<0.01). Basal plasmacytosis was found in 92.86% of moderate to severe disease.
Conclusion: The study concludes that the GS system strongly correlates with both MES and TWLS in patients with UC which could be used concurrently to determine the extent of healing and optimise treatment strategy. Findings of basal plasmacytosis, mucin depletion, dysplasia and pseudopolyps are associated with moderate to severe disease activity.