Histological Activity Predicts Relapse in Pediatric Ulcerative Colitis Despite Mucosal Healing: A Multicenter Study From the Pediatric Ibd Porto Group of Espghan Publisher Pubmed



Trivic Mazuranic I ; Aloi M ; Bramuzzo M ; Chiantese C ; D Arcangelo G ; Gattenlohner S ; Gianolio L ; Granot M ; Hizarcioglu Gulsen H ; Hussey S ; Kang B ; Kolho K L ; De Laffolie J ; Lega S Show All Authors
Source: Journal of Crohn's and Colitis Published:2026

Abstract

Background and Aims: The STRIDE-II recommends mucosal healing as a treatment goal for patients with ulcerative colitis (UC), yet histological remission is increasingly recognized as a meaningful therapeutic target. This study aims to evaluate whether histological activity among patients with mucosal healing is associated with the risk of subsequent relapse. Methods: A multicenter, retrospective cohort study comprised of 19 IBD centers from 9 countries. The study included children diagnosed with UC from January 2012 to December 2022 who had a follow-up endoscopy demonstrating mucosal healing and for whom histology scores were available. Histological remission was defined as a Nancy index (NI) ≤ 1, a Geboes score (GS) ≤ 2, or a Robarts Histopathology Index (RHI) ≤ 3. Histological healing was defined as a histological score of 0. Results: We included 193 children (mean age at diagnosis 10.8 ± 4.3 years; 128 [66%] female). At endoscopy, 155 (80%) children were in histological remission, and 107 (55%) had histological healing. During a median follow-up of 2.4 (range 1-8.7) years, 65 (34%) children experienced a relapse. Patients with histological healing had lower relapse rates than those with residual histological activity (27% vs. 41%; P = .031). Cox regression analysis showed that the absence of histological remission was significantly associated with a higher risk of relapse during follow-up (hazard ratio [HR] 0.499, 95% confidence interval [CI] 0.289-0.863, P = .013), with an even stronger association in those without histological healing (HR 0.469, 95% CI 0.284-0.773, P = .003). Conclusion: Histological activity is a risk factor for relapse of UC in children with mucosal healing. © The Author(s) 2026. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights)