Abstract
Background: Mucosal histological activity is increasingly valued as a treatment endpoint in inflammatory bowel diseases (IBD). In the Asia Pacific region, however, the utility and acceptability of IBD histology as a treatment endpoint is uncertain due to the heterogeneity of IBD prevalence, resourcing, and level of knowledge among practitioners. There is an opportunity to engage clinicians to harmonise histology reporting and collaborate with pathologists in this field. To this end, we developed statements to determine their consensus through anonymous voting on histological features, processing, reporting, and relevance to treatment outcomes in ulcerative colitis and Crohn’s disease.
Methods: Representatives of the Asia Pacific Association of Gastroenterology, in collaboration with pathologists, voted anonymously in accordance with modified Delphi methodology on statements relevant to IBD and histology. Domains of interest were histological features of ulcerative colitis and Crohn’s disease, relevance to clinical management, and the potential utility of artificial intelligence in grading histological disease severity. Level of evidence and recommendation grade were included in accordance with the NHMRC guidelines of Australia.
Results: Consensus was reached on 37 statements concerning definitions, pathology processing and reporting, scoring system, and relevance to clinical outcomes (Figure). There was uncertainty on escalating treatment when histological remission is not achieved, preventing consensus on this statement. Knowledge gaps were identified over the role of artificial intelligence.
Conclusion: These consensus statements provide recommendations, with specific relevance to the Asia Pacific region, on the role of histology in IBD ways to harmonise its use. The consensus statements will promote understanding and applicability in research and in the routine management of IBD.
Poster presentation.