Objective Histological remission is being increasingly acknowledged as a therapeutic endpoint in patients with UC. The work hereafter described aimed to evaluate the concordance between three histological classification systems—Geboes Score (GS), Nancy Index (NI) and RobartsHistopathologyIndex (RHI), as well as to evaluate their association with the endoscopic outcomes and the faecal calprotectin (FC) levels. Design Biopsy samples from 377 patients with UC were blindly evaluated using GS, NI and RHI. The results were compared with the patients’ Mayo Endoscopic Score and FC levels. Result GS, NI and RHI have a good concordance concerning the distinction between patients in histological remission or activity. RHI was particularly close to NI, with 100% of all patients classified as being in remission with NI being identified as such with RHI and 100% of all patients classified as having activity with RHI being identified as such with NI. These scores could also predict the Mayo Endoscopic Score and the FC levels, with their sensitivity and specificity levels depending on the chosen cut-offs. Moreover, higher FC levels were statistically associated with the presence of neutrophils in the epithelium, as well as with ulceration or erosion of the intestinal mucosa. Conclusions GS, NI and RHI histopathological scoring systems are comparable in what concerns patients’ stratification into histological remission/activity. Additionally, FC levels are increased when neutrophils are present in the epithelium and the intestinal mucosa has erosions or ulcers. The presence of neutrophils in the epithelium is, indeed, the main marker of histological activity.

This article describes cases of anti-tumor necrosis factor (TNF)-α-induced autoimmune hepatitis and evaluates the outcome of these patients in relation to their immunosuppressive strategy. A retrospective analysis of medical records was performed in our center, in order to detect cases of autoimmune hepatitis (AIH) associated with anti-TNF biologic agents. We describe and analyze eight cases of AIH following anti-TNF therapy, 7 with infliximab and 1 with adalimumab. A distinction should be made between induction of autoimmunity and clinically evident autoimmune disease. Liver biopsy is useful in detecting the role of the TNF-α antagonist in the development of AIH. The lack of relapse after discontinuing immunosuppressive therapy favors, as in this case series, an immune-mediated drug reaction as most patients with AIH have a relapse after treatment is suspended. Although AIH related to anti-TNF therapy is rare, a baseline immunological panel along with liver function tests should be performed in all patients with autoimmune disease before starting biologics.

Background and Aims: Histological healing has emerged as a promising therapeutic goal in ulcerative colitis. This is especially important in the context of biologic therapies. The objectives of the present study were to investigate the ability of infliximab to induce histological remission in Ulcerative Colitis (UC) patients and to explore the utility of faecal calprotectin and lactoferrin in predicting histological activity. Methods: Multi-centre, single-cohort, open-label, 52-week trial including moderately to severely biologic-naïve UC patients receiving intravenous infliximab (5mg/kg). The primary outcome was the proportion of patients with histological remission (Geboes index ≤3.0) after 8 weeks of treatment, scored by two independent pathologists. Results: Twenty patients were included. The rate of histological remission increased from 5% at baseline to 15% and 35% at week 8 and week 52, respectively. At week 8, 40% of patients were in clinical remission (Mayo ≤2) and 45% achieved mucosal healing (Mayo endoscopy subscore 0-1). At week 52, 25% of patients had clinical, endoscopic and histological remission. Faecal calprotectin and lactoferrin showed the highest correlation with histological activity at week 8 (AUC 94%, p=0.017; and 96% p=0.013, respectively) and both markers revealed an excellent positive predictive value for this outcome at this time point (100%, p=0.017; and 94% p=0.013, respectively). Conclusions: Infliximab was able to induce histological remission. There was a good agreement between histology and faecal biomarkers. Faecal calprotectin and lactoferrin were good predictors of histological remission. Our data support inclusion of histology as a treatment target complementary to endoscopy in clinical trials when evaluating therapeutic response in UC. Clinicaltrials.gov Identifier: NCT01408810.