Medication Withdrawal With Normal or Near-normal Histology in Ulcerative Colitis is Associated With Clinical Relapse

Goals: We sought to understand the clinical course and risk of dysplasia in persons with UC who achieve near or complete normalization of histology.

Background: Histologic remission and normalization in ulcerative colitis (UC) is associated with improved clinical outcomes. We sought to understand the clinical course and risk of dysplasia in persons with UC who achieve near or complete normalization of histology.

Study: We performed a retrospective single-centred study of persons with UC who were in endoscopic remission with normal histology. Pathology slides were reread by a gastrointestinal-expert pathologist and both right and left colon were scored using the Geboes score. The primary outcome was time to clinical relapse, with secondary outcomes including episodes of dysplasia and colectomy.

Results: Seventy-eight persons had normal histology reported, although only 2 had completely normal histology on expert review. Approximately one-fifth of persons developed a clinical relapse at a mean of 4.7 years. Neither right nor left-sided colon histology was predictive of future clinical relapse. Forty-three percent of those who withdrew their IBD-therapy had a future clinical relapse, and were more likely to relapse than those who did not withdraw therapy (HR: 4.89, 95% CI: 1.32-18.08). There were zero episodes of dysplasia in follow-up, and 2 persons who relapsed ended up receiving a colectomy.

Conclusions: Persons with UC who achieve normal or near-normal histology have moderate rates of clinical relapse. Physicians should be cautious when considering withdrawing IBD-therapy as this was associated with an increased risk of clinical relapse.