Lobaton T, et al. - The role of histology as a risk factor for clinical relapse (CR) in patients in both clinical and endoscopic remission was evaluated. The physicians revealed that the presence of acute histological inflammatory activity (AHA) was a risk factor for clinical relapse in ulcerative colitis (UC) patients in clinical and endoscopic remission.

• The physicians enrolled patients with left-sided or extensive UC in clinical and endoscopic remission (Mayo endoscopic subscore ≤1) undergoing colonoscopy for dysplasia surveillance with random colonic biopsies between 2005-2015.
• They evaluated basal plasmacytosis, acute (AHA), and the chronic (CHA) histological inflammatory activity of all biopsy sets.

• The physicians included 113 patients.
• At inclusion, median time in clinical remission was 27 months (IQR 15-56).
• Within the first year, 8% of patients relapsed and 33% during the whole follow-up period.
• The presence of AHA was associated with CR within the first year of follow-up, alone (P = 0.048) or together with a past flare within the previous 12 months (P = 0.01) in the univariate analysis.
• AHA remained the only risk factor for relapse (RR = 7.5; IC95%; 1.8-29.9; P = 0.005), together with a flare within the previous 12 months, in the multivariate analysis.