Course Of UC Research Articles

Lack of Benefit for Early Escalation to Advanced Therapies in Ulcerative Colitis: Critical Appraisal of Current Evidence.

Although ulcerative colitis [UC] shares many common pathways and therapeutic options with Crohn's disease [CD], CD patients are four times more likely to undergo surgery 10 years into their disease in the biological era and are more likely to have extraintestinal manifestations than UC patients. Early treatment in CD has been demonstrated to modify the natural history of the disease and potentially delay surgery. Previous reviews on this topic have borrowed their evidence from CD to make UC-specific recommendations. This review highlights the emergence of UC-specific data from larger cohort studies and a comprehensive individual patient data systemic review and meta-analysis to critically appraise evidence on the utility of early escalation to advanced therapies with respect to short-, medium-, and long-term outcomes. In UC, the utility of the early escalation concept for the purposes of changing the natural history, including reducing colectomy and hospitalizations, is not supported by the available data. Data on targeting clinical, biochemical, endoscopic, and histological outcomes are needed to demonstrate that they are meaningful with regard to achieving reductions in hospitalization and surgery, improving quality of life, and minimizing disability. Analyses of different populations of UC patients, such as those with 'relapsing & remitting' disease or with severe or complicated disease course, are urgently needed. The costs and risk/benefit profile of some of the newer advanced therapies should be carefully considered. In this clinical landscape, it appears premature to advocate an indiscriminate 'one size fits all' approach to escalating to advanced therapies early during the course of UC.

Modern treatment management strategy for inflammatory bowel diseases

MODERN TREATMENT MANAGEMENT STRATEGY FOR INFLAMMATORY BOWEL DISEASES Olexander I. Poida1, Volodymyr M. Melnyk1, Mykola D. Kucher1, Tetiana G. Kravchenko1, Myroslav I. Kryvoruk2 1 O. O. Bogomolets National Medical University, Taras Shevchenko Boulevard, 13, Kyiv 01601, Ukraine 2 UNCE (Utility non-commercial enterprise) «Kyiv City Clinical Hospital №18», Taras Shevchenko Boulevard, 13, Kyiv 01601, Ukraine Introduction. Enrichment of knowledge in etiology and pathogenesis, improvement of existing and development of new methods and technologies, strategies and tactics for IBD will contribute to improving the results of their diagnosis and treatment. The aims. To improve the treatment results of patients with IBD by developing and implementing modern treatment management strategies for their diagnosis and treatment. Material and methods: The modern diagnostic and treatment management of IBD has been developed and put into practice. It provides for the improvement of diagnosis and differential diagnosis of diseases, justification and selection of the optimal personalized method of treatment, depending on the characteristics of the clinical course, the severity of the patient's condition, and the existing risk of complications. Results. From 2013 to 2022, 1340 patients, 732 (54.6 %) men and 608 (45.4 %) women with IBD were treated at the Coloproctology Center of Ukraine. There were 812 (60.6 %) patients with ulcerative colitis and 528 (39.4 %) with CD. Conservative therapy received 1107 (82.6 %) patients, and surgical treatment – 233 (17.4 %). Postoperative complications occurred in 37 (15.9 %) patients, and deaths – were in 5 (2.1 %). All patients in the conservative treatment group had positive therapeutic dynamics, and improvement of morphological changes in the intestinal mucosa according to the control colonoscopy and biopsy. Positive functional results and life quality improvement were obtained in most patients after surgical treatment. Conclusion. 1. Conservative treatment involves the use of modern and highly effective drugs that can modify the course of IBD and thus prevent complications. 2. The choice of surgical strategy and treatment tactics is reasonable in the presence of a high risk of adverse course of UC and CD, as well as the development of complications that pose a threat to the patient's life. 3. Implementation of the proven treatment management for inflammatory bowel disease allowed: to increase to 82.6 % the number of patients who are indicated conservative therapy and reduce the risk of recurrence of these diseases; to decrease the number of surgical interventions to 17.4 %, increase the performance of surgical interventions according to relative indications to 62.5 %, even before the occurrence of severe complications of diseases; reduce the incidence of postoperative complications to 15.9 %, postoperative mortality to 2.1 %, and improve functional outcomes and quality of life of operated patients. Keywords: bowel, inflammatory diseases, diagnosis, treatment.

P085 Gut microbiota profile changes in patients with Ulcerative Colitis

Abstract Background Ulcerative Colitis (UC) is a chronic, relapsing inflammatory disease of the lower gastrointestinal tract. The frequency of UC is increasing worldwide, however, existing methods for both diagnostics and treatment of this disease are not efficient enough. It is known that besides comprised immune response, environmental and genetic factors, gut microbiota play a major role in the onset and course of UC. Therefore, efforts are currently being made to find and develop new gut microbiome-based tools to improve the management of UC. The aim of this study was to identify changes in the gut microbiome during active and quiescent UC. Methods Study included 72 subjects, who were divided into three age- and sex-matched groups: control (n=25), active UC (n=27) and quiescent UC (n=20). Total DNA was extracted from faeces, which was further subjected to the next generation sequencing of 16S rRNA-coding gene V1-V2 hypervariable region on MiSeq (Illumina) platform. Further, bioinformatics and statistical analysis were performed. Results Bacterial α-diversity, as assessed by Richness, Shannon and Simpson diversity indexes, revealed that control patients had highest α-diversity compared to patients with active UC or quiescent UC (p<0.05), but there were no differences between UC disease states (p>0.05). Significant microbial community clusters (β-diversity), as assessed by the Bray-Curtis dissimilarity index, were identified between control subjects and patients with active or quiescent UC (p=0.02, p<0.01, respectively). However, no significant clusters were found between different disease states (p=0.22). In-between samples dissimilarity assessed by Bray-Curtis dissimilarity index showed that samples from control subjects had higher in-between sample similarity (mean 0.542 ± 0.117) than patients with active (mean 0.638 ± 0.161) and quiescent (0.6 ± 0.145) UC. In addition, 16, 13 and 27 core taxa were identified in active, quiescent UC and control group, respectively. Differential abundance of Cuneatibacter, Faecalibacterium and Prevotellamassilia genera was detected when comparing control vs UC (both active and quiescent), Paraprevotella and Cuneatibacter genera – control vs active UC, Faecalibacterium, Prevotellamassilia, Mediterraneibacter and Cuneatibacter genera – control vs quiescent UC. Conclusion In conclusion, this study revealed both qualitative and quantitative gut microbiota changes in active and quiescent UC. Study was funded by the Research Council of Lithuania (Grant No. S-MIP-20-56).

P142 Evaluation of quantitative phase imaging for automated assessment of histopathological remission in patients with Ulcerative Colitis

Abstract Background Ulcerative colitis (UC) is characterized by chronic intestinal inflammation. Histological remission has become an efficacy outcome in clinical trials and might have the potential to modify the course of UC. Quantitative phase imaging including digital holographic microscopy (DHM) can be used for objective and automated evaluation of tissue morphology and density. Our study aimed to evaluate DHM for quantifying histological inflammation in UC patients. Methods In a monocentric prospective study, UC patients undergoing colonoscopy were included. Disease activity was measured by the total Mayo Score. DHM was used to determine the refractive index (RI) in mucosal biopsy samples obtained during colonoscopy. RI values were correlated with histological disease activity as assessed by the Nancy histological index [NHI]. Results In total, mucosal biopsy samples from 21 UC patients were included to the analysis. On average, UC patients had a moderate disease activity as reflected by a partial Mayo score of 3.1 (SEM ± 0.6), an endoscopic Mayo subscore of 1 (SEM ± 0.2) and a total Mayo score of 4.1 (SEM ± 0.8). The mean NHI was 1.3 (SEM ± 0.2) and the mean RI was 1.349 (SEM ± 0.0003). RI values as determined by DHM correlated strongly with the histological disease activity as determined the NHI (p<0,001 and R2=0.282). Similarly, a marked correlation was found using alternative histopathological indices (Geboes score, Riley index, Robarts histopathological index; all p<0.001). Conclusion Our data demonstrate that DHM is appropriate to assess intestinal inflammation in UC patients and that it may be an alternative or supplemental tool to conventional histopathological assessment.

Glycoprotein α-Subunit of Glucosidase II (GIIα) is a novel prognostic biomarker correlated with unfavorable outcome of urothelial carcinoma

BackgroundUrothelial carcinoma (UC) is among the most prevalent malignancies. The muscle-invasive bladder cancer (MIBC) shows an invasive feature and has poor prognosis, while the non-muscle invasive bladder cancer (NMIBC) shows a better prognosis as compared with the MIBC. However, a significant proportion (10%–30%) of NMIBC cases progress to MIBC. Identification of efficient biomarkers for the prediction of the course of UC remains challenging nowadays. Recently, there is an emerging study showed that post-translational modifications (PTMs) by glycosylation is an important process correlated with tumor angiogenesis, invasion and metastasis. Herein, we reported a data-driven discovery and experimental validation of GANAB, a key regulator of glycosylation, as a novel prognostic marker in UC.MethodsIn the present study, we conducted immunohistochemistry (IHC) assay to evaluate the correlation between the expression levels of GANAB protein and the prognosis of UC in our cohort of 107 samples using whole slide image (WSI) analysis. In vitro experiments using RNAi were also conducted to investigate the biological functions of GANAB in UC cell lines.ResultsWe observed that positive GANAB protein expression was significantly correlated with poor prognosis of UC in our cohort, with p-value of 0.0017 in Log-rank test. Notably, tumor cells at the invasive front of the tumor margin showed stronger GANAB expression than the tumor cells inside the tumor body in UCs. We further validated that the elevated expression levels of GANAB were significantly correlated with high grade tumors (p-values of 1.72 × 10–10), advanced stages (6.47 × 10–6), and elevated in luminal molecular subtypes. Moreover, knocking-down GANAB using RNAi in UM-UC-3 and T24 cells inhibited cell proliferation and migration in vitro. Knockdown of GANAB resulted in cell cycle arrest at G1 phase. We demonstrated that GANAB mediated HIF1A and ATF6 transcriptional activation in the ER stress signaling, and regulated the gene expression of cell cycle-related transcriptional factors E2F7 and FOXM1.ConclusionsThe elevated expression of GANAB is a novel indicator of poorer prognosis of UC. Our data suggests that GANAB is not only a new and promising prognostic biomarker for UC, but also may provide important cues for the development of PTM-based therapeutics for UC treatment.

P180 The prevalence and clinical course of atypical distribution of inflammation in newly diagnosed ulcerative colitis

Abstract Background Ulcerative colitis (UC) is characterized by continuous mucosal inflammation extending from rectum to the proximal lesion. However, there are cases of atypical distribution of inflammation, such as appendiceal orifice inflammation (AOI), skipped lesion, and rectal sparing. This study aimed to evaluate the prevalence and clinical course of atypical distribution of inflammation in newly diagnosed UC. Methods Between 2013 and 2021, 374 patients who underwent a colonoscopy at the time of diagnosis of UC were retrospectively reviewed. Clinical courses including relapse rate within 1-year, 2-year of diagnosis and exposure to immunomodulator or biologics during follow-up were retracted from the prospective IBD registry (ClinicalTrial.gov, NCT02193464). Atypical UC was defined as patients with AOI, skipped lesion or rectal sparing at initial colonoscopy. The clinical courses and changes of endoscopic findings were compared between typical UC group and atypical UC group. Results Of 374 patients, 116 (31.0%) categorized as atypical UC; specifically, 90 (24.1%) showed AOI, 17 (4.5%) showed rectal sparing and 49 (13.1%) showed skipped lesion. When 90 patients with AOI were reclassified according to the extent of inflammation, 62(16.6%) had a localized inflammation at peri-appendiceal area, 13(3.5%) had an inflammation of the entire cecum, 15(4.0%) had an inflammation extends to the proximal A-colon. The clinical courses of atypical UC were not different from typical UC group, however, patients with skipped lesion showed a lower 1-year relapse rate compared to those without skipped lesion (P=0.042). Of 96 patients with atypical UC who underwent follow-up endoscopy, 73 (75.8%) demonstrated a typical distribution of UC at their follow-up colonoscopy. Conclusion Atypical distribution of UC including AOI, skipped lesion, and rectal sparing are not uncommon in patient with newly diagnosed UC. However, most of these features do not appear to correlate significantly with prognosis in the clinical course of UC. In majority of patients with atypical UC, the lesion turned into typical UC on follow-up colonoscopy.

Long-term prognosis of ulcerative colitis and its temporal changes between 1986 and 2015 in a population-based cohort in the Songpa-Kangdong district of Seoul, Korea

ObjectiveNo population-based study has evaluated the natural course of UC over three decades in non-Caucasians. We aimed to assess the long-term natural course of Korean patients with UC in a...

Celiac Disease in a Patient with Ulcerative Colitis and Primary Sclerosing Cholangitis

Celiac disease (CD) has been found in 2-3% of patients with PSC. There is a known association between Ulcerative Colitis and PSC. Studies show that 2-7.5% of patients with UC develop PSC. The combination of CD, UC, and PSC is even more uncommon. This is a case of a 57-year-old woman with history of UC and PSC who was found to have CD on annual endoscopy. Patient is a 57-year-old Caucasian woman with history of UC/PSC who presented for annual EGD/colonoscopy. She was initially diagnosed with UC by colonoscopy at age 40 after a one-year history of recurrent diarrhea. Since then, she has been managed on Apriso with yearly colonoscopies. At age 46, she was diagnosed with PSC after a cholestatic liver profile prompted ERCP, which revealed focal left intrahepatic ductal stricture. Since then, she has been managed on Actigall and follows up with Hepatology every 6 months. Five years later, she was found to have advanced liver disease secondary to her PSC when ERCP revealed dominant biliary stricture. Two years later, at age 54, she was found to have small proximal esophageal varices on endoscopy, which portended advancement of liver disease with significant portal hypertension. Esophageal varices were controlled with endoscopic ligation. Subsequent endoscopies have been negative for esophageal varices. On her annual EGD, she was found to have duodenal irregularity; subsequent biopsies revealed blunting of villi. She was diagnosed with CD, complicating her PSC and UC. Her CD is currently being managed by gluten-free diet. PSC and UC have a long-standing known association. Both conditions are autoimmune in nature with p-ANCA positivity. Classically, they present together in middle-aged men; their presentation in a woman makes our case unique to begin with. PSC and CD have a less well-known association, most likely due to immunologic connection. However, very few previous case studies have examined association and clinical outcomes between UC and co-existing CD. According to Giovanni et al., IBD could obfuscate the symptoms of CD because they share common symptoms such as weight loss, abdomen pain, and diarrhea. Another prior case series of IBD patients with CD found that 4/5 of these patients with co-existing UC and CD tend to have pancolitis. However, these patients did not have PSC. Thus, our patient with all three conditions co-existing together represents a unique case as there is limited knowledge regarding the course of UC in patients with both PSC and CD.

Caspase recruitment domain (CARD) family (CARD9, CARD10, CARD11, CARD14 and CARD15) are increased during active inflammation in patients with inflammatory bowel disease

BackgroundThe CARD family plays an important role in innate immune response by the activation of NF-κB. The aim of this study was to determine the gene expression and to enumerate the protein-expressing cells of some members of the CARD family (CARD9, CARD10, CARD11, CARD14 and CARD15) in patients with IBD and normal controls without colonic inflammation.MethodsWe included 48 UC patients, 10 Crohn’s disease (CD) patients and 18 non-inflamed controls. Gene expression was performed by RT-PCR and protein expression by immunohistochemistry. CARD-expressing cells were assessed by estimating the positively staining cells and reported as the percentage.ResultsThe CARD9 and CARD10 gene expression was significantly higher in UC groups compared with CD (P < 0.001). CARD11 had lower gene expression in UC than in CD patients (P < 0.001). CARD14 gene expression was higher in the group with active UC compared to non-inflamed controls (P < 0.001). The low expression of CARD14 gene was associated with a benign clinical course of UC, characterized by initial activity followed by long-term remission longer than 5 years (P = 0.01, OR = 0.07, 95%CI:0.007–0.70). CARD15 gene expression was lower in UC patients versus CD (P = 0.004). CARD9 protein expression was detected in inflammatory infiltrates; CARD14 in parenchymal cells, while CARD15 in inflammatory and parenchymal cells. CARD9−, CARD14− and CARD15 − expressing cells were significantly higher in patients with active UC versus non-inflamed controls (P < 0.05).ConclusionThe CARD family is involved in the inflammatory process and might be involved in the IBD pathophysiology.

P750 Predictors of quick remission after cyclosporine A therapy in Paediatric ulcerative colitis

Cyclosporin A is a second-line drug in ulcerative colitis that failed to respond to intravenous glucocorticoids according to ECCO/ESPGHAN consensus . Up-to-date CsA induced mucosal healing (Mayo 0 score) is the only factor predicting the lack of course deterioration in the future. The aim of the study was to investigate a presence of factors contributing to positive CsA therapy outcome. It is a retrospective, single center study. We describe a clinical characteristic of 59 children (33 females, 26 males), mean age of 13.7 years, mean disease duration 32 months, who underwent CsA treatment in the course of UC in years 2005–2015. The primary endpoint was clinical remission (defined as PUCAI<10) or clinical response (defined as decrease in PUCAI scoring for at least 20 points) at Day 8. Response/remission at Day 8 was achieved in 43 out of 59 (81%) and 31 out of 59 (58%) patients, respectively. Clinical (PUCAI score), laboratory (CsA concentration), endoscopic (disease extension and severity) and demographic (age, age of onset, disease duration) data were used as independent variables in analysis of discrimination between: group with clinical response vs. no response and group with clinical remission vs. no remission. PUCAI score, UC duration and Mayo score create the model which predict clinical remission at Day 8 with sensitivity 0.8 and specificity 0.66. No model was established to discriminate between groups with clinical response vs. no response. PUCAI score, UC duration and Mayo score contribute to response for induction therapy with CsA in children with UC.

THE MODERN VIEW OF THE PATHOGENESIS AND LABORATORY DIAGNOSTICS OF ULCERATIVE COLITIS (LITERATURE REVIEW)

The basic theory of the pathogenesis of inflammatory bowel disease (IBD) is currently considered a violation of immune activation and immune response against its own antigens to the intestinal flora in genetically predisposed individuals. “The gold standard” diagnosis of UC is colonoscopy with biopsy morphological study. Due to the invasiveness, complexity in the preparing and conducting, the high cost of endoscopy there is a need in the application of laboratory biomarkers UC, with which you can select a group of persons subject to an in-depth examination of the instrumental. The review highlights the modern view of the pathogenesis of the disease, the ability to use a variety of laboratory biomarkers in the diagnosis of UC, for monitoring the effectiveness of the therapy, as predictors of severe course of UC, therapeutic response prediction and early detection of recurrence

Appendectomy does not decrease the risk of future colectomy in UC: results from a large cohort and meta-analysis

ObjectivesEarly appendectomy is inversely associated with the development of UC. However, the impact of appendectomy on the clinical course of UC is controversial, generally favouring a milder disease course. We...

P117 The first description of primary sclerosing cholangitis (PSC) in association with collagenous colitis: was this predictable?

follow-up period (p = 0.44). The cumulative probabilities of starting anti-TNF agents were not significantly different between appendectomized and non-appendectomized patients (5.0% vs. 6.1% at 10 years and 5.0% vs. 10.4% at 20 years, p = 0.44). Also, the cumulative probabilities of starting corticosteroids and azathioprine/6-mercaptopurine were not significantly different between the two groups (corticosteroids, p = 0.85, azathioprine/6-mercaptopurine, p = 0.71). Conclusions: These results indicated that appendectomy had no significant beneficial effect on the clinical course of UC in regard to medication use and colectomy in the Korean population. This study was supported by a grant of the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (A120176).

P182 Multiparametric evaluation of Crohn's disease: possible role of intestinal healing beyond mucosal healing

Results: Among 887 patients, a subgroup of 439 CD and 173 UC were included with a mean follow-up of 19 and 15 years respectively. One year after the diagnosis 147 CD patients had NS CD. At 5 years and at the maximum follow-up respectively, 83/147 (56%) and 15/147 (10%) patients still had NS CD. Complications were strictures (29%), fistulizing disease (18%), perianal disease (37%). Immunomodulators and antiTNF were required in 79% and 54% of patients respectively. Prognostic factors for persistent NS CD were older age at diagnosis (38 vs 26 years, p = 0.005), no corticosteroid during the first year (p = 0.036). In UC, 142 patients had NS disease one year after the diagnosis. 102/142 (72%) and 62 patients (44%) had NS UC after 5 years and at the maximum follow-up respectively. Surgery occurred in 19 patients (13%) after a mean time a 164 months. Immunomodulators were needed in 66 patients (47%) and anti-TNF in 37 patients (26%). NS UC was associated with absence of hospitalization for active UC over the first 5 years (p = 0.009) and during the total course of UC (p < 0.0001), no intake of corticosteroid during the first year (p = 0.03). Conclusions: In our cohort representing referall centre recruitment, nearly all CD patients and 2/3 of UC with NS disease at diagnosis became severe with time. Old age at diagnosis was associated with NS CD outcome while absence of hospitalisation during the first year was associated with NS UC outcome. Absence of steroid use during the first year was associated with NS outcome in both diseases.

P014 The inflammasome induces macrophage-mediated disruption of the epithelial barrier

and ER-alpha expression, Ki-67 and Tunel were evaluated by immunohystochemical methods. Results: ER-beta, ER-alpha expression and their ratio, assessed in normal mucosa, in UC and in UC-dysplasia, did not show significant changes while in UC-carcinoma revealed a dramatic fall of ER-beta expression (p < 0.01) and still more ER-beta/ERalpha (p < 0.005). Apoptosis and Tunel/Ki-67 ratio demonstrated a statistically significant progressive increase from UC to UCcarcinoma through UC-dysplasia. Conclusions: Our experience assessed modifications of ERs expression, apoptosis and cell proliferation in dysplasiacarcinoma sequence in the course of UC. We observed a dramatic fall of ER-beta, ER-beta/ER-alpha and a progressive increase of apoptosis in progressive steps from long-lasting UC to UC-carcinoma. As observed in adenoma model, the ERbeta drop could be a biomarker of dysplasia progression and a relevant point in the study of carcinogenesis in the course of UC. Further studies are warranted.

P015 The influence of COX-1/COX-2 inhibitors on the Na/Li-countertransport and Na, K, 2Cl-cotransport in erythrocytes of rats with experimental colitis

and ER-alpha expression, Ki-67 and Tunel were evaluated by immunohystochemical methods. Results: ER-beta, ER-alpha expression and their ratio, assessed in normal mucosa, in UC and in UC-dysplasia, did not show significant changes while in UC-carcinoma revealed a dramatic fall of ER-beta expression (p < 0.01) and still more ER-beta/ERalpha (p < 0.005). Apoptosis and Tunel/Ki-67 ratio demonstrated a statistically significant progressive increase from UC to UCcarcinoma through UC-dysplasia. Conclusions: Our experience assessed modifications of ERs expression, apoptosis and cell proliferation in dysplasiacarcinoma sequence in the course of UC. We observed a dramatic fall of ER-beta, ER-beta/ER-alpha and a progressive increase of apoptosis in progressive steps from long-lasting UC to UC-carcinoma. As observed in adenoma model, the ERbeta drop could be a biomarker of dysplasia progression and a relevant point in the study of carcinogenesis in the course of UC. Further studies are warranted.

Comparison of demographic and clinical characteristics of patients with early vs. adult vs. late onset ulcerative colitis

Background & aimsThere is limited data comparing influence of age on the presentation, clinical course, and therapeutic response of patients with ulcerative colitis. We aimed to compare the demographic and clinical characteristics of patients diagnosed with UC in older age vs. adulthood vs. early age. MethodsFive-hundred sixty one patients with UC seen at our center from 1995 to 2011 were categorized into early onset (EO), adult onset (AO) and late onset (LO) due to age at date of initial diagnosis. Patients diagnosed younger than age 17 were defined as EO, while those diagnosed between 17 and 60 were defined as AO and older than age 60 as LO. All patients were analyzed for demographic and clinical characteristics. ResultsThere was a male predominancy among LO patients (50% vs. 57.7% vs. 78.6%, p=0.004). Patients with EO UC were more likely to be non-smokers (p<0.001), and had higher family history of UC (p=0.02). Patients with EO UC had more steroid use (p=0.03), total colectomy (p=0.04), presence of chronic active disease (p=0.04) rates when compared with AO and LO groups. Patients in EO group had higher overall probability of surgery in 1, 5 and 10years, when compared with patients in LO group (p=0.02), but it wasn't different between EO and AO groups (p=0.09). ConclusionsOur study showed that clinical course of UC was more aggressive in younger ages. Also the difference between the demographic characteristics suggests that different age groups have different risk factors for the disease development.

Does the severity of primary sclerosing cholangitis influence the clinical course of associated ulcerative colitis?

Background and aimsUlcerative colitis (UC) associated with primary sclerosing cholangitis (PSC) is usually clinically mild. The aim of the study was to assess whether there is an association between severity...

The role and importance of endoscopic mucosal healing in ulcerative colitis

Endoscopy with biopsy is widely employed in the management of patients with UC. The indications for endoscopy in UC are numerous but all share the common thread of impacting medical decision-making for the benefit of patient care. Recently, the role of endoscopy has been extended to the realm of prognostication, as treatment response and disease relapse historically have been very unpredictable. Although not part of standard care today, it is anticipated that future research will allow for development of highly predictive markers of the future course of UC. In addition, endoscopy may have a role in risk stratification of patients with respect to colorectal cancer, possibly leading to increased frequency of surveillance endoscopy in high-risk patients in the future.