Histologic findings at diagnosis as predictive markers of clinical outcome in pediatric ulcerative colitis

Background: The role of histological inflammation at diagnosis as a possible prognostic factor for disease course has not been investigated.Aims: To assess whether histologic findings at diagnosis could predict clinical outcomes and evaluate the association between clinical, biochemical, endoscopic, and histological findings.Methods: Prospective single-center study including pediatric UC patients with a minimum follow-up of 12 months. The association between histological activity (Nancy Index, Robarts Histopathology Index, and Geboes Score) and 12-month clinical outcomes was evaluated. Secondarily, we assessed the correlation between histological scores and endoscopic and inflammatory markers at the diagnosis. Inter-observer agreement for histologic and endoscopic scores was also evaluated.Results: Forty-nine UC patients were included. No association was found between 1-year clinical relapse and the three histological indices at diagnosis ( p > 0.05). Good concordance was found among the three histological scores ( p < 0.001), and between all histological and endoscopic indices ( p < 0.05). No correlation was found between histologic scores and serum inflammatory markers. Inter-observer agreement was good for eMayo, Nancy and Robarts score ( k = 0.71, k = 0.74 and k = 0.68, respectively) and moderate for Geboes ( k = 0.46).Conclusions: Histological findings at diagnosis cannot be used as a predictor of the disease course. The three histological scores used in routine clinical practice show an overall good correlation and reliability.(c) 2023 The Authors. Published by Elsevier Ltd on behalf of Editrice Gastroenterologica Italiana S.r.l. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )