P0347 Correlation between histologic disease activity in the distal and proximal colon in Ulcerative Colitis: A flexible sigmoidoscopy is insufficient to assess histology
Bibliographic record
Abstract
Abstract Background Ulcerative Colitis (UC) is a chronic inflammatory bowel disease characterized by relapsing inflammation of the colon. Current therapeutic goals emphasize clinical and endoscopic remission; however, histological remission has emerged as an important target due to its association with reduced relapse rates and improved long-term outcomes. Despite this, limited data exist on the concordance of histological activity between colonic segments, especially in UC patients in clinical remission. This study investigates the correlation between histological disease activity in the rectosigmoid colon (RSC) and other colonic segments in patients with UC in clinical remission. Methods This prospective study analyzed data from 203 UC patients in clinical remission, defined as a partial Mayo score ≤2 and rectal bleeding score = 0 for at least three months. Colonoscopies with segmental biopsies were performed, and histological activity was assessed using the Geboes score. Histological remission was defined as a Geboes score <2A.0, while active disease was classified as ≥3.1. Correlation between histological activity in the RSC and other colonic segments was evaluated using Spearman’s correlation coefficients and logistic regression. Statistical significance was defined as p < 0.05. Results Among the 203 patients, the median age was 45 years, with 55.1% having pancolitis. Histological activity in the RSC showed poor correlation with other colonic segments. In patients with a RSC Geboes score of ≥3.1, the correlation coefficient between the RSC and descending colon was 0.05 (p = 0.62), between the RSC and transverse colon was -0.03 (p = 0.71), and between the RSC and right colon was 0.12 (p = 0.09). In patients with a RSC Geboes score of <2A.0, the correlation coefficient between the RSC and descending colon was 0.12 (p = 0.22), between the RSC and transverse colon was 0.05 (p = 0.59), and between the RSC and right colon was 0.18 (p = 0.01). Even among patients with pancolitis, histological concordance between segments remained low. These findings underscore substantial segmental variability in histological activity. Conclusion Flexible sigmoidoscopy (FS) is commonly used to monitor UC due to its practicality; however, our findings suggest FS may not reliably reflect proximal histological disease. The lack of concordance highlights the limitations of FS in accurately assessing histological remission, including in patients with pancolitis or extensive colitis. Full colonoscopy with segmental biopsies remains the gold standard for comprehensive disease evaluation and management. Further research is warranted to refine histologic assessment strategies in UC.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".