Histological Remission Does Not Predict Clinical Relapse in Crohn’s Disease

Overview

This prospective analysis from the STORI cohort evaluated histological remission (HR) as a predictor of clinical relapse in Crohn’s disease (CD) patients in remission. Despite correlations with endoscopic findings and biomarkers, histological scores failed to predict relapse, with fecal calprotectin being the only significant predictor.

Background

Crohn’s disease is a chronic inflammatory bowel disease characterized by progressive bowel damage and fluctuating disease activity. Achieving deep remission, including clinical, endoscopic, and biological remission, is the current therapeutic goal. While histological remission is an established predictor of relapse in ulcerative colitis, its role in CD remains unclear. This study aimed to clarify whether histological inflammation predicts clinical relapse in CD patients in remission.

Data Highlights

Key Findings

• Histological remission rates varied between 41% and 61% depending on the scoring system used.
• 46% of patients experienced clinical relapse during follow-up.
• Patients with histological remission had a lower relapse rate (37%) compared to those without (56%) based on the Nancy score, but this difference was not statistically significant.
• Among patients with mucosal healing, histological remission did not significantly reduce relapse risk (34% vs 44%, p=0.18).
• Histological scores did not predict clinical relapse in multivariate analysis.
• Fecal calprotectin was the only significant predictor of clinical relapse.

Clinical Implications

Histological remission should not be used alone to predict clinical relapse risk in Crohn’s disease patients in remission. Monitoring fecal calprotectin levels remains a more reliable tool for relapse prediction. Routine histological scoring for relapse risk assessment is not recommended in clinical practice for CD.

Conclusion

Despite correlations with endoscopic and biomarker data, histological remission does not predict clinical relapse in Crohn’s disease patients in remission. Fecal calprotectin remains the preferred biomarker for relapse risk assessment.

References

1. STORI Cohort Analysis 2024 -- Evaluating the Role of Histological Remission in Predicting Clinical Relapse Among Crohn’s Disease Patients