Clinical, Endoscopic, and Histological Characteristics of Severe Immune Checkpoint Inhibitor-Induced Colitis

<b>Background:</b> Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy. They can cause immune-mediated colitis (IMC), a potentially severe adverse event. Current data on severe IMC (grade 3-4) are limited, particularly regarding clinical, endoscopic, and histological features. <b>Methods:</b> We conducted a multicenter, retrospective observational study promoted by GETECCU, including adults with solid tumors who developed grade 3-4 IMC requiring hospitalization and systemic therapy. Clinical symptoms, endoscopic findings (Mayo and UCEIS indices), and histological features were systematically collected and analyzed. <b>Results:</b> A total of 196 patients were included. Diarrhea was universal (median 8 bowel movements/day), with 76% reporting abdominal pain and 39% rectal bleeding. Endoscopy (n = 139) revealed vascular pattern loss (80%), mucosal lesions (69%), and Mayo scores ≥2 in 69%. Histopathology (n = 141) showed abnormalities in 85%, including cryptitis (50%), lymphocytic infiltration (48%), and crypt abscesses (37%). Notably, 72% of patients with normal endoscopy had histological inflammation. Endoscopic severity correlated with bleeding and impaired general condition but not with stool frequency or pain intensity. Histological and endoscopic severity were modestly associated. <b>Conclusions:</b> Severe IMC presents with heterogeneous clinical, endoscopic, and histological features, with limited correlation between these domains. Endoscopic findings were often ulcerative and inflammatory, yet histological abnormalities were frequently present even in endoscopically inactive disease. These findings highlight the importance of biopsy in all suspected IMC cases and underscore the need for validated multidimensional assessment tools for accurate diagnosis and management of severe IMC.

Authors

Institutions

Publication Details

Journal
Journal of Clinical Medicine
Published
2026-01-02
DOI
https://doi.org/10.3390/jcm15010353
Primary Topic
Cancer Immunotherapy and Biomarkers
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Clinical, Endoscopic, and Histological Characteristics of Severe Immune Checkpoint Inhibitor-Induced Colitis

Begoña Álvarez Herrero, María Calvo Íñiguez, José Miranda Bautista, Pablo Miles Wolfe García et al.
Journal of Clinical Medicine
Cancer Immunotherapy and Biomarkers
article

Clinical, Endoscopic, and Histological Characteristics of Severe Immune Checkpoint Inhibitor-Induced Colitis

Begoña Álvarez Herrero, María Calvo Íñiguez, José Miranda Bautista, Pablo Miles Wolfe García, Belén Herreros Martínez, A Gutiérrez, J X Segarra-Ortega, Laura López Couceiro, Fernando Martínez de Juan, Raquel Vicente Lidón, Pablo Ladrón Abia, X Serra Ruiz, Luis Menchén, Alejandro Garrido Marín, García María José, Francisco Rodríguez‐Moranta, Empar Sáinz, Silvia Patrícia Ortega Moya, Pere Garriga, E Betoré Glaría, Ingrid Ordàs, Virginia Matallana Royo, Santiago García López, Inmaculada Alonso Abreu, Carla Folguera, Coral Rivas Rivas, M Marques Cami, R Ferreiro-Iglesias, M.V. Lorenzo, Cristina Polo Cuadro, Mañosa Míriam, Alexandra Ruiz Cerulla, Irene García de la Filia Molina, Óscar Moralejo Lozano, Patricia Sanz Segura, Manuel Barreiro-de Acosta, Yamile Zabana, Gerard Surís, Raquel Mena Sánchez, Elena Céspedes Martínez, N. Marcos, Santiago Frago Larramona, Javier Santos Fernández, Esther Rodríguez González, Cristina Roig Ramos, Lucía Madero Velázquez, Eduard Brunet Mas, Cristina Almingol Crespo, Marta Gascón Ruiz, Diego Casas Deza, Coral Tejido Sandoval, Francisco Mesonero Gismero
article en

Abstract

<b>Background:</b> Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy. They can cause immune-mediated colitis (IMC), a potentially severe adverse event. Current data on severe IMC (grade 3-4) are limited, particularly regarding clinical, endoscopic, and histological features. <b>Methods:</b> We conducted a multicenter, retrospective observational study promoted by GETECCU, including adults with solid tumors who developed grade 3-4 IMC requiring hospitalization and systemic therapy. Clinical symptoms, endoscopic findings (Mayo and UCEIS indices), and histological features were systematically collected and analyzed. <b>Results:</b> A total of 196 patients were included. Diarrhea was universal (median 8 bowel movements/day), with 76% reporting abdominal pain and 39% rectal bleeding. Endoscopy (n = 139) revealed vascular pattern loss (80%), mucosal lesions (69%), and Mayo scores ≥2 in 69%. Histopathology (n = 141) showed abnormalities in 85%, including cryptitis (50%), lymphocytic infiltration (48%), and crypt abscesses (37%). Notably, 72% of patients with normal endoscopy had histological inflammation. Endoscopic severity correlated with bleeding and impaired general condition but not with stool frequency or pain intensity. Histological and endoscopic severity were modestly associated. <b>Conclusions:</b> Severe IMC presents with heterogeneous clinical, endoscopic, and histological features, with limited correlation between these domains. Endoscopic findings were often ulcerative and inflammatory, yet histological abnormalities were frequently present even in endoscopically inactive disease. These findings highlight the importance of biopsy in all suspected IMC cases and underscore the need for validated multidimensional assessment tools for accurate diagnosis and management of severe IMC.

Journal of Clinical MedicineVol. 15(1)
Hospital Universitario de Canarias (ES), Hospital de Sant Pau (ES), Bellvitge University Hospital (ES), Hospital Universitari Arnau de Vilanova (ES), Hospital General Universitario Gregorio Marañón (ES), Hospital Universitari i Politècnic La Fe (ES), Hospital Universitario Nuestra Señora de Candelaria (ES), Althaia (ES), Consorci Sanitari de Terrassa (ES), Complejo Hospitalario de Salamanca (ES), Biogipuzkoa Health Research Institute (ES), Hospital Royo Villanova (ES), Fundación Instituto Valenciano de Oncología (ES), Hospital Sierrallana (ES), Hospital Universitario Puerta de Hierro Majadahonda (ES), Hospital Universitario Araba (ES), Instituto de Investigación Marqués de Valdecilla (ES), Hospital Clínic de Barcelona (ES), Hospital Universitario de Burgos (ES), Hospital de Galdakao (ES), Hospital de Sabadell (ES), Vall d'Hebron Hospital Universitari (ES), Mútua Terrassa (ES), Hospital Del Mar (ES), Instituto de Investigación Sanitaria Aragón (ES), Hospital General Universitario de Alicante Doctor Balmis (ES), Hospital San Pedro (ES), Donostiako Unibertsitate Ospitalea (ES), Instituto de Investigación Sanitaria de Santiago (ES), Hospital Universitari Joan XXIII de Tarragona (ES), Hospital Universitari Germans Trias i Pujol (ES), Hospital Comarcal de Inca (ES), Hospital General San Jorge (ES), Hospital Marina Baixa (ES), Hospital Universitario Infanta Sofía (ES), Hospital Universitario Ramón y Cajal (ES), Complejo Hospitalario Universitario de Toledo (ES), Complejo Asistencial Universitario de Palencia (ES), Complejo Hospitalario de Ourense (ES), Hospital Universitario Infanta Cristina (ES)
Good health and well-being
Openalex Percentile: Top 99%
Cancer Immunotherapy and Biomarkers
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.