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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Limited validity of Mayo endoscopic subscore in ulcerative colitis with concomitant primary sclerosing cholangitis
Pavel Wohl, Alzbeta Krausova, Petr Wohl, Ondrej Fabian, Lukas Bajer, Jan Brezina, Pavel Drastich, Mojmir Hlavaty, Petra Novotna, Michal Kahle, Julius Spicak, Martin Gregor
Pavel Wohl, Lukas Bajer, Jan Brezina, Pavel Drastich, Mojmir Hlavaty, Julius Spicak, Department of Gastroenterology, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic
Alzbeta Krausova, Petra Novotna, Martin Gregor, Department of Integrative Biology, Institute of Molecular Genetics of the Czech Academy of Sciences, Prague 14220, Czech Republic
Petr Wohl, Department of Metabolism and Diabetes, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic
Ondrej Fabian, Clinical and Transplant Pathology Centre, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic
Michal Kahle, Department of Data Analysis, Statistics and Artificial Intelligence, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic
Co-corresponding authors: Pavel Wohl and Martin Gregor.
Author contributions: Wohl Pa designed the study; Wohl Pe, Bajer L, Brezina J, Drastich P and Hlavaty M recruited and treated the patients and collected and analyzed the data; Fabian O performed the histological evaluations; Novotna P analyzed the data; Kahle M performed the statistical analyses; Wohl Pa, Krausova A and Gregor M wrote the manuscript; All authors have read and approve the final manuscript.
Supported by Grant Agency of the Ministry of Health of the Czech Republic, No. NV17-31538A; Grant Agency of the Czech Republic No. 20-16520Y and No. 21-21736S; and Ministry of Education, Youth and Sports of the Czech Republic Project, No. LX22NPO05102.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Institute for Clinical and Experimental Medicine and Thomayer Hospital with Multi-Center Competence (G16-06-25) and performed in accordance with the Declaration of Helsinki.
Clinical trial registration statement: Our study does not fulfill the criteria for a clinical trial according to the legislation of the Czech Republic and implemented EU laws. To conduct our prospective study, only ethical approval was required from the Czech Grant Agency and the Department of Gastroenterology at the Institute for Clinical and Experimental Medicine, where the study was conducted.
Informed consent statement: All study participants or their legal guardians provided informed written consent prior to study enrollment.
Conflict-of-interest statement: Martin Gregor received research funding from the Ministry of Education, Youth and Sports of the Czech Republic and the Grant Agency of the Czech Republic and the Grant Agency of the Ministry of Health of the Czech Republic. Pavel Wohl received funding from the Grant Agency of the Ministry of Health of the Czech Republic. Alzbeta Krausova received funding from the Grant Agency of the Czech Republic.
Data sharing statement: The data underlying this article cannot be shared publicly due to the risk of impacting the privacy of individuals that participated in this study. The data will be shared upon reasonable request to the corresponding authors.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Martin Gregor, PhD, Senior Lecturer, Senior Research Fellow, Department of Integrative Biology, Institute of Molecular Genetics of the Czech Academy of Sciences, Videnska 1083, Prague 14220, Czech Republic.
martin.gregor@img.cas.cz
Received: June 26, 2024
Revised: September 13, 2024
Accepted: October 9, 2024
Published online: November 16, 2024
Processing time: 125 Days and 14.7 Hours
BACKGROUND
Ulcerative colitis (UC) with concomitant primary sclerosing cholangitis (PSC) represents a distinct disease entity (PSC-UC). Mayo endoscopic subscore (MES) is a standard tool for assessing disease activity in UC but its relevance in PSC-UC remains unclear.
AIM
To assess the accuracy of MES in UC and PSC-UC patients, we performed histological scoring using Nancy histological index (NHI).
METHODS
MES was assessed in 30 PSC-UC and 29 UC adult patients during endoscopy. NHI and inflammation were evaluated in biopsies from the cecum, rectum, and terminal ileum. In addition, perinuclear anti-neutrophil cytoplasmic antibodies, fecal calprotectin, body mass index, and other relevant clinical characteristics were collected.
RESULTS
The median MES and NHI were similar for UC patients (MES grade 2 and NHI grade 2 in the rectum) but were different for PSC-UC patients (MES grade 0 and NHI grade 2 in the cecum). There was a correlation between MES and NHI for UC patients (Spearman's r = 0.40, P = 0.029) but not for PSC-UC patients. Histopathological examination revealed persistent microscopic inflammation in 88% of PSC-UC patients with MES grade 0 (46% of all PSC-UC patients). Moreover, MES overestimated the severity of active inflammation in an additional 11% of PSC-UC patients.
CONCLUSION
MES insufficiently identifies microscopic inflammation in PSC-UC. This indicates that histological evaluation should become a routine procedure of the diagnostic and grading system in both PSC-UC and PSC.
Core Tip: Ulcerative colitis (UC) with concomitant primary sclerosing cholangitis (PSC) represents a distinct disease entity (PSC-UC). Our results highlight the limitations of endoscopic examination in uncovering microscopic inflammatory lesions, resulting in the erroneous classification of PSC-UC patients as healthy. To mitigate the risk of underdiagnosis, histopathological examination should therefore be an essential component of the diagnostic approach for UC in PSC patients.
