Retrospective Cohort Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 7, 2015; 21(37): 10654-10661
Published online Oct 7, 2015. doi: 10.3748/wjg.v21.i37.10654
Histological healing after infliximab induction therapy in children with ulcerative colitis
Anna Wiernicka, Sylwia Szymanska, Joanna Cielecka-Kuszyk, Maciej Dadalski, Jaroslaw Kierkus
Anna Wiernicka, Maciej Dadalski, Jaroslaw Kierkus, Department of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland
Sylwia Szymanska, Joanna Cielecka-Kuszyk, Department of Pathology, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland
Author contributions: Wiernicka A collected and analyzed the data, and wrote the manuscript; Kierkus J designed and supervised the study and revised the manuscript; Dadalski M supervised statistical analysis, collected the clinical data, and revised the manuscript; Szymanska S and Cielecka-Kuszyk J collected and analyzed biopsy specimens; all the authors have read and approved the final version to be published.
Supported by The Children’s Memorial Health Institute Internal Grant S129/2013 (in part).
Institutional review board statement: The study was reviewed and approved by the local Ethics Committee of the Children’s Memorial Health Institute, Warsaw, Poland (nr 179/KBE/2014).
Conflict-of-interest statement: The authors declare that there are no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Jaroslaw Kierkus, Department of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics, The Children’s Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland. j.kierkus@czd.pl
Telephone: +48-22-8157392 Fax: +48-22-8157392
Received: March 7, 2015
Peer-review started: March 11, 2015
First decision: April 20, 2015
Revised: May 14, 2015
Accepted: June 16, 2015
Article in press: June 16, 2015
Published online: October 7, 2015
Abstract

AIM: To verify the impact of induction therapy with infliximab (IFX) on mucosal healing in children with ulcerative colitis (UC).

METHODS: The study included all UC pediatric patients treated with IFX at our center over the last 10 years. The data were collected from patients’ medical charts and analyzed retrospectively. A total of 16 patients with UC underwent colonoscopy with sample collection before and after three IFX injections. Pediatric Ulcerative Colitis Activity Index (PUCAI) was used to assess the clinical condition; endoscopic features were classified according to the Baron scale; and histological changes were evaluated according to the protocol of The British Society of Gastroenterology and Geboes Index. Clinical response was defined as a ≥ 20-point reduction in PUCAI index, and clinical remission as PUCAI index < 10 points. Endoscopic mucosal remission was defined as completely normal (score 0) on the Baron scale. Histological remission was defined as grade 0 in the Geboes Index. To assess correlation between variables, Spearman’s rank correlation coefficient was used.

RESULTS: Clinical remission (PUCAI < 10) at week 8 was achieved in 68.75% of investigated subjects. Endoscopic mucosal remission at week 8 (Baron 0) was observed in 12.5% of patients. Histological remission (Geboes 0) after induction therapy with IFX was noticed in 18.75% cases. A general histological improvement, expressed by normal surface and crypt architecture, number of crypts, and lamina propria cellularity, was observed in six (37.5%) patients; there was no improvement in nine (56.25%) individuals, and worsening was observed in one (3.75%) case. Changes were not related to UC location. A reduction of inflammatory process was observed in 10 (62.5%) patients; there were no changes in four (25%) individuals, and the inflammation became more severe in two (12.5 %) cases. Simultaneous clinical, endoscopic and histological improvement of parameters assessing disease activity at week 8 was noticed in six (37.5%) patients. 55.5% of investigated patients with normal mucosa seen on endoscopy showed no inflammation on histology. A Baron score of 2 and 3 showed a good correlation with histology results (78.2% of patients with a Geboes Index ≥ 3).

CONCLUSION: IFX has a positive histological effect in more than one-third of UC patients. IFX reduces intestinal inflammation and improves clinical condition.

Keywords: Ulcerative colitis, Endoscopy, Histopathology, Inflammation, Infliximab

Core tip: The impact of infliximab induction therapy on histological healing in pediatric ulcerative colitis (UC) patients is unknown. The present study demonstrates that infliximab induction therapy had a positive influence on histological changes expressed by normal surface, crypt architecture, number of crypts, and lamina propria cellularity in 37.5% of UC patients. The treatment was effective in reducing intestinal inflammation as assessed by the Geboes Index (62.5% of patients). Furthermore, it was shown that there was no significant correlation of histological healing with endoscopic remission and clinical remission.