Knowledge and attitudes towards the use of histological assessments in ulcerative colitis by gastroenterologists vs pathologists

Table 1 Demographics and study cohort characteristics, n (%)

	Gastroenterologists (n = 77)	Pathologists (n = 12)
Age (yr)
< 30	4 (5.2)	0 (0.0)
30-40	30 (39.0)	1 (8.3)
41-50	15 (19.5)	4 (33.3)
51-60	19 (24.7)	4 (33.3)
> 60	9 (11.7)	3 (25.0)
Location
New South Wales	46 (59.7)	8 (66.7)
Victoria	11 (14.3)	2 (16.7)
Queensland	11 (14.3)	2 (16.7)
Western Australia	8 (10.4)	0 (0.0)
Australian Capital Territory	1 (1.3)	0 (0.0)
Highest level of education
Bachelor of medicine/bachelor of surgery	51 (66.2)	11 (91.7)
Masters	10 (13.0)	0 (0.0)
PhD	16 (20.8)	1 (8.3)
What is your predominant practice
Staff specialist	24 (31.2)	10 (83.3)
University academic work	1 (1.3)	0 (0.0)
Visiting medical officer	13 (16.9)	0 (0.0)
Private practice	23 (29.9)	2 (16.7)
In training program	16 (20.8)	0 (0.0)
How many IBD patients do you see each week
0-1	5 (6.5)	N/A
2-5	31 (40.3)	N/A
6-10	18 (23.4)	N/A
> 10	23 (29.9)	N/A
Involved in regular IBD multidisciplinary meeting
Yes	35 (45.5)	6 (50.0)
No	42 (54.5)	6 (50.0)

IBD: Inflammatory bowel disease; N/A: Not applicable.

Table 2 Attitudes towards histology and histological scoring systems, n (%)

	Gastroenterologists (n = 77)	Pathologists (n = 12)
The role of histological activity in IBD is
Not established	3 (3.9)	1 (8.3)
Preliminary	1 (1.3)	0 (0.0)
Emerging	31 (40.3)	4 (33.3)
Established	42 (54.5)	7 (58.3)
Histological remission is more important to achieve than endoscopic remission
Disagree	4 (5.2)	N/A
Somewhat disagree	13 (16.9)	N/A
Neither agree nor disagree	10 (13.0)	N/A
Somewhat agree	36 (46.8)	N/A
Agree	14 (18.2)	N/A
What histological scoring system does your pathologist routinely or frequently use in their reports
Geboes	2 (2.6)	0 (0.0)
Nancy index	3 (3.9)	1 (8.3)
RHI	1 (1.3)	0 (0.0)
They do not routinely use a scoring system	71 (92.2)	10 (83.3)
Other		IBD-DCA score (n = 1)
I would like to use a histological scoring system for my IBD patients
Never	8 (10.4)	4 (33.3)
Rarely	10 (13.0)	1 (8.3)
Occasionally	14 (18.2)	1 (8.3)
Sometimes	23 (29.9)	3 (25.0)
Always	22 (28.6)	3 (25.0)
Which scoring systems have undergone the most validation
Modified Riley score	1 (1.3)	1 (8.3)
Geboes score	13 (16.9)	3 (25.0)
Nancy index	20 (26.0)	5 (41.7)
RHI	9 (11.7)	3 (25.0)
Truelove and Richards score	5 (6.5)	0 (0.0)
Not sure	49 (63.6)	7 (58.3)
What Geboes score is considered histological remission
< 1.1	2 (2.6)	1 (8.3)
< 2.1	7 (9.1)	2 (16.7)
< 3.1	4 (5.2)	0 (0.0)
< 4.1	1 (1.3)	0 (0.0)
Not sure	63 (81.8)	9 (75.0)
What Nancy index is considered histological remission
0	10 (13.0)	2 (16.7)
≤ 1	4 (5.2)	3 (25.0)
≤ 2	0 (0.0)	0 (0.0)
≤ 3	0 (0.0)	0 (0.0)
Not sure	63 (81.8)	7 (58.3)
What Robarts histopathology index is considered histological remission
≤ 2	4 (5.2)	1 (8.3)
≤ 3	6 (7.8)	1 (8.3)
≤ 4	0 (0.0)	0 (0.0)
≤ 5	0 (0.0)	1 (8.3)
Not sure	67 (87.0)	9 (75.0)

RHI: Robarts histopathology index; IBD: Inflammatory bowel disease; N/A: Not applicable.

Table 3 Impact of histological disease activity on treatment management in clinical scenarios, n (%)

Scenario	Never	Not often	Sometimes	Often	Always
If a patient is in clinical and endoscopic remission, but has histological activity, then I will escalate medical therapy	14 (18.2)	35 (45.5)	20 (26.0)	5 (6.5)	3 (3.9)
If a patient is in clinical and endoscopic remission, but has an elevated faecal calprotectin (> 100 μg/g) and histological activity, then I will escalate medical therapy	4 (5.2)	18 (23.4)	31 (40.3)	19 (24.7)	5 (6.5)
If a patient is in clinical, endoscopic and histological remission, (but prior colonoscopy showed Mayo 1 endoscopic disease), then I will de-escalate medical therapy	7 (9.1)	19 (24.7)	36 (46.8)	15 (19.5)	0 (0.0)
If a patient is in clinical remission, with their last 2 colonoscopies showing endoscopic and histological remission, then I will de-escalate medical therapy	2 (2.6)	2 (2.6)	31 (40.3)	38 (49.4)	4 (5.2)
If a patient with ulcerative colitis has other risk factors for colon cancer, then I will aim to achieve histological remission	0 (0.0)	7 (9.1)	14 (18.2)	27 (35.1)	29 (37.7)

Table 4 Inflammatory bowel disease histology knowledge scores

	Gastroenterologists (n = 77)	Pathologists (n = 12)
IBD histology knowledge score [median (IQR)]	9.0 (7.8-11.0)	8.0 (6.5-10.0)
Type of subspecialist
General gastroenterologist	8.0 (7.0-9.0)	N/A
IBD subspecialist	10.5 (7.3-14)	N/A
Interventional endoscopist	9.0 (4.5-9.8)	N/A
Hepatologist	10.5 (8.5-11)	N/A
Gastroenterology trainee	8.5 (6.0-10.0)	N/A
Predominant practice
Staff specialist	11.0 (9.0-13.0)	N/A
Visiting medical officer	8.0 (8.0-9.0)	N/A
Private practice	8.0 (6.3-9.8)	N/A
In training program	8.5 (6.0-10.0)	N/A
Highest level of education
Bachelor degree	9.0 (8.0-10.0)	N/A
Masters	8.0 (7.0-11.0)	N/A
PhD	11.0 (7.0-14.0)	N/A
Involved in regular IBD multidisciplinary meeting	35 (45.5%)	6 (50.0%)
Yes	9.5 (8.0-11.0)	N/A
No	8.0 (6.0-10.0)	N/A

IQR: Interquartile range; N/A: Not applicable; IBD: Inflammatory bowel disease.

Table 5 Significant predictors of inflammatory bowel disease histology knowledge score for gastroenterologists on univariate and multivariate analyses

	Univariate analysis P value	Multivariate analysis P value
Type of subspecialty	0.005	0.03
Predominant practice	0.004	0.005
Involvement in IBD MDT	0.002	0.009
Highest level of education	0.02

IBD: Inflammatory bowel disease; MDT: Multidisciplinary team.