Usefulness of Different Pathological Scores to Assess Healing of the Mucosa in Inflammatory Bowel Diseases: A Real Life Study
Authors: Gabrio Bassotti
Moris Cadei
Elisabetta Antonelli
Francesco Lanzarotto
Vincenzo Villanacci
Anna Bozzola
Journal: Scientific reports (2017)
Discipline: Multidisciplinary
Keywords: remission; inflammatory bowel diseases; histological healing; mucosa; pathological score
Affiliations: Pathology Section, Department of Molecular and Translational Medicine, Brescia, Italy., Gastroenterology Unit, Perugia General Hospital, Perugia, Italy., Gastroenterology Section, 1st Medical Clinic, Spedali Civili and University of Brescia, Brescia, Italy., Gastroenterology and Hepatology Section, Department of Medicine, University of Perugia School of Medicine, Perugia, Italy. .

Abstract:  The concept of remission for patients with inflammatory bowel diseases has recently evolved, and should also include histological healing of the mucosa, difficult to evaluate since there is no agreement on pathological scores and those available are quite complex to use in the daily routine. We evaluated the possible usefulness of a simplified pathological score to assess histological healing of the mucosa in inflammatory bowel diseases patients compared with four commonly proposed pathological scores. Slides from 24 patients (12 Crohn's disease, 12 ulcerative colitis, age range 24-62 years), pre- and post-treatment with biological agents and displaying endoscopic remission were assessed by two pathologists. Pre- and post-treatment results and the time employed to calculate the various scores were obtained. All scores were useful to document highly significant post-treatment decreases of histological activity. However, the simplified score needed significant less time to be calculated for each slide, had high inter-rater agreement, and avoided subjectivity from the pathologists. The simplified score is easy to calculate and seems apt to document histological healing of the mucosa, in a manner similar to the more complex scores. It remains to be established whether this score could simplify the daily routinary practice in this context. 

Retracted: No

PubPeer comments:
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 Images duplication from two previously papers. The Sci Rep paper is an original paper. Could the authors explain why the images published were NON original and reproduced from two other papers. Were the editors reviewers informed ? ![file] , 
 the study was carried out according to ethical guidelines for retrospective studies using anonymized data , 
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 Could the authors explain why an image used for commercial purposes by BIO-OPTICA has been used in an original paper? There is a conflict of interest? Was it disclosed? ![file] , 
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 As described in the method patients were examined before and after a treatment. Methods Pathological slides (H E) from 24 IBD patients (12 CD with ileocolonic involvement, 12 ulcerative pancolitis, age range 24u201362 years), pre- and post-treatment with biological agents and in clinical remission, were retrieved from our archives after calculating that a minimum number of 6 subjects per group was needed with an u03b1 error of = 0.05 and a u03b2 error of 0.10. Biological agents utilized were infliximab (6 CD patients, all 12 UC patients) and adalimumab (6 CD patients); median duration of therapy was 15 (15u201325) months for the entire group, 15 (15u201334) months for CD and 18 (15u201327) months for UC, respectively. Pre- and post-treatment clinical status and was assessed by means of the Partial Mayo Score (PMS) for UC30, the Harvey-Bradshaw index (BHI) for CD31, and the quality of life with the Short Inflammatory Bowel Disease Questionnaire (S-IBDQ)32. , 
 Can the authors explain when and were these patients were investigated? The information on the instutions where the study was carried out is a critical requirement by any ethical standard and is part of CONSORT guidelines on reporting clinical studies. Also, knowing the institution and time frame is essential for data transparency and retrival. Adidtionally the authors state:  Since this was a retrospective study, no individual patient identification was involved and no study-driven clinical intervention was performed; therefore, our IRB waived formal review and approval, deeming the study to be an extension of existing procedures. This sentence needs to be explained. Was the project submitted for approval and the IRB decided to do not examine it? Was this done in written? Could these data made available? ,