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      Reclassifying Pseudopolyps in Inflammatory Bowel Disease: Histologic and Endoscopic Description in the New Era of Mucosal Healing

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          Abstract

          Introduction

          In this study, we identify the frequency of pseudopolyps (PPs) with normal histology and their association to surrounding tissue.

          Methods

          Patients were enrolled in a study identifying endoscopic characteristics of PPs (n = 29) or were collected as part of our IBD biobank (n = 16). Statistical analysis included Stata v.15.0. chi-square and Student t-test.

          Results

          A total of 45 patients with 117 PP biopsies were identified. More patients with healed PP were in endoscopic remission compared with those with inflammatory PP (82.6% vs 17.4%, respectively).

          Conclusion

          This is the first study to find mucosal healing of PPs and its association with deep remission.

          Abstract

          “Healed” pseudopolyps, which are projecting masses of scar tissue developed during the healing phase of IBD, were detected in patients with healed mucosa in the colon (endoscopic remission) more often than “inflammatory” pseudopolyps, which reflect active inflammation in the colon.

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          Most cited references14

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          Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-intestinal Manifestations, Pregnancy, Cancer Surveillance, Surgery, and Ileo-anal Pouch Disorders.

          Fernando Magro, Paolo Gionchetti, Rami Eliakim … (2017)
          Article 0 comments Cited 569 times – based on 0 reviews     Review now
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            Inflammatory bowel disease: clinical aspects and established and evolving therapies.

            Daniel Baumgart, William J Sandborn (2007)
            Crohn's disease and ulcerative colitis are two idiopathic inflammatory bowel disorders. In this paper we discuss the current diagnostic approach, their pathology, natural course, and common complications, the assessment of disease activity, extraintestinal manifestations, and medical and surgical management, and provide diagnostic and therapeutic algorithms. We critically review the evidence for established (5-aminosalicylic acid compounds, corticosteroids, immunomodulators, calcineurin inhibitors) and emerging novel therapies--including biological therapies--directed at cytokines (eg, infliximab, adalimumab, certolizumab pegol) and receptors (eg, visilizumab, abatacept) involved in T-cell activation, selective adhesion molecule blockers (eg, natalizumab, MLN-02, alicaforsen), anti-inflammatory cytokines (eg, interleukin 10), modulation of the intestinal flora (eg, antibiotics, prebiotics, probiotics), leucocyte apheresis and many more monoclonal antibodies, small molecules, recombinant growth factors, and MAP kinase inhibitors targeting various inflammatory cells and pathways. Finally, we summarise the practical aspects of standard therapies including dosing, precautions, and side-effects.
            Article 0 comments Cited 511 times – based on 0 reviews     Review now
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              Severity of inflammation is a risk factor for colorectal neoplasia in ulcerative colitis.

              Matthew Rutter, Brian Saunders, Kay Wilkinson … (2004)
              Patients with ulcerative colitis are at increased risk of colorectal cancer. It is widely believed that this is secondary to colonic inflammation. However, the severity of colonic inflammation has never been shown to be a risk factor. We devised a case-control study of patients with long-standing extensive ulcerative colitis to examine various potential risk factors for neoplasia. All cases of colorectal neoplasia detected from our surveillance program between January 1, 1988, and January 1, 2002, were studied (n = 68). Each patient was matched with 2 control patients from the same surveillance population (n = 136). Matching was for sex, colitis extent, age at onset, duration of colitis, and year of index surveillance colonoscopy. Segmental colonoscopic and histological inflammation was recorded by using a simple score (0, normal; 1, quiescent/chronic inflammation; and 2, 3, and 4, mild, moderate, and severe active inflammation, respectively). Other data collected included history of primary sclerosing cholangitis, family history of colorectal cancer, and smoking and drug history (mesalamine 5-aminosalicylic acid, azathioprine, and folate). Univariate analysis showed a highly significant correlation between the colonoscopic (odds ratio, 2.5; P = 0.001) and histological (odds ratio, 5.1; P < 0.001) inflammation scores and the risk of colorectal neoplasia. No other factors reached statistical significance. On multivariate analysis, only the histological inflammation score remained significant (odds ratio, 4.7; P < 0.001). In long-standing extensive ulcerative colitis, the severity of colonic inflammation is an important determinant of the risk of colorectal neoplasia. Endoscopic and histological grading of inflammation could allow better risk stratification for surveillance programs.
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                Author and article information

                Contributors
                Mona Rezapour
                Journal
                Journal ID (nlm-ta): Crohns Colitis 360
                Journal ID (iso-abbrev): Crohns Colitis 360
                Journal ID (publisher-id): crohnscolitis360
                Title: Crohn's & Colitis 360
                Publisher: Oxford University Press (US )
                ISSN (Electronic): 2631-827X
                Publication date (Print): October 2019
                Publication date (Electronic): 15 October 2019
                Publication date PMC-release: 15 October 2019
                Volume: 1
                Issue: 3
                Electronic Location Identifier: otz033
                Affiliations
                [1 ] Department of Gastroenterology and Hepatology, University of California Los Angeles , Los Angeles, California
                [2 ] Department of Gastroenterology and Hepatology, University of Miami , Miami, Florida
                [3 ] Department of Medicine, University of Miami , Miami, Florida
                [4 ] Nebraska Food for Health Sciences, University of Nebraska-Lincoln , Lincoln, Nebraska
                [5 ] Ameripath , Shreveport, Louisiana
                Author notes
                Address correspondence to: Mona Rezapour, MD MHS, University of California Los Angeles, Digestive Diseases, 7345 Medical Center Drive Suite 420, West Hills, CA 91307 ( monarezapour@ 123456gmail.com ).
                Article
                Publisher ID: otz033
                DOI: 10.1093/crocol/otz033
                PMC ID: 6798790
                SO-VID: 46986259-f18b-4030-9b0c-c76e99102647
                Copyright © © 2019 Crohn's & Colitis Foundation. Published by Oxford University Press on behalf of Crohn's & Colitis Foundation.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 01 August 2019
                Date: 07 August 2019
                Date: 15 October 2019
                Page count
                Pages: 7
                Funding
                Funded by: Takeda
                Award ID: K23KD117054
                Funded by: National Institutes of Health 10.13039/100000002
                Categories
                Subject: Observations And Research

                Keywords: healed pseudopolyps,inflammatory bowel disease,inflammatory pseudopolyps
                Data availability:
                Keywords: healed pseudopolyps, inflammatory bowel disease, inflammatory pseudopolyps

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