Remission Stage Of Ulcerative Colitis Research Articles

Imbalanced mucosal microcirculation in the remission stage of ulcerative colitis using probe-based confocal laser endomicroscopy

BackgroundMicrocirculatory disturbance is an important factor in the pathogenesis of Inflammatory Bowel Disease (IBD) but there have been few studies in this field. Confocal Laser Endomicroscopy (CLE) has been used over the last 10 years and has made it possible to explore the changes in microcirculation of the colonic mucosa.MethodsWe retrospectively selected patients who underwent probe-based Confocal Laser Endomicroscopy (pCLE) between 2014 and 2016. There were 7 patients with ulcerative colitis (UC) in clinical remission and 7 healthy subjects included in this study; all the UC patients’ medical data were reviewed. For each patient, three segments of the colon were examined using pCLE including the ascending, transverse/descending and sigmoid colon. In each segment, the representative pCLE images of the three sites were selected for analysis. Four indicators, including Mean Vessel Diameter (MVD), Diameter Standard Deviation (DSD), Functional Capillary Density-long (FCDL) and Functional Capillary Density-area (FCDA), were measured with a specially designed detection software algorithm. The four indicators were compared between UC patients and healthy subjects. According to the different blood flow patterns, three types of distribution were established: the Around (A), Cobweb (C) and Deficiency (D) type. The relationships between the recurrence and blood flow patterns of UC patients were analyzed.ResultsMVD, DSD, FCDL and FCDA were 10.62 ± 0.56 μm, 2.23 ± 0.26, 0.030 ± 0.019 μm and 0.289 ± 0.030 for the healthy subjects and 11.06 ± 1.10 μm, 2.68 ± 0.29, 0.026 ± 0.005 μm and 0.272 ± 0.034 for the UC patients, respectively. Compared with healthy subjects, DSD was significantly increased and FCDA was significantly decreased (P < 0.01 for both). There was no difference in MVD and FCDL between UC patients and healthy subjects. The type A and type C blood flows were observed in healthy subjects (66.67 and 33.33%, respectively) while type C appears more in UC patients (71.3%) and type D blood flow could only be found in UC patients (14.29%) P < 0.01. UC patients who showed Type D blood flow had a shorter recurrence interval.ConclusionsSome local mucosal capillary density in UC patients was decreased, particularly in the inflammation-affected segment. The three mucosal blood flow patterns can be used as an indicator of mucosal healing.

Molecular profiling of mucosal tissue associated microbiota in patients manifesting acute exacerbations and remission stage of ulcerative colitis.

Dysbiosis of intestinal microflora has been postulated in ulcerative colitis (UC), which is characterized by imbalance of mucosal tissue associated bacterial communities. However, the specific changes in mucosal microflora during different stages of UC are still unknown. The aim of the current study was to investigate the changes in mucosal tissue associated microbiota during acute exacerbations and remission stages of UC. The mucosal microbiota associated with colon biopsy of 12 patients suffering from UC (exacerbated stage) and the follow-up samples from the same patients (remission stage) as well as non-IBD subjects was studied using 16S rRNA gene-based sequencing and quantitative PCR. The total bacterial count in patients suffering from exacerbated phase of UC was observed to be two fold lower compared to that of the non-IBD subjects (p = 0.0049, Wilcox on matched-pairs signed rank tests). Bacterial genera including Stenotrophomonas, Parabacteroides, Elizabethkingia, Pseudomonas, Micrococcus, Ochrobactrum and Achromobacter were significantly higher in abundance during exacerbated phase of UC as compared to remission phase. The alterations in bacterial diversity with an increase in the abnormal microbial communities signify the extent of dysbiosis in mucosal microbiota in patients suffering from UC. Our study helps in identifying the specific genera dominating the microbiota during the disease and thus lays a basis for further investigation of the possible role of these bacteria in pathogenesis of UC.

Utility of fecal calprotectin as a discriminative biomarker between ulcerative colitis and irritable bowel syndrome and its ability to be used for the assessment of the remission stage of ulcerative colitis

Fecal calprotectin (FC) has been proposed in recent studies as a sensitive, specific biomarker for the diagnosis of ulcerative colitis (UC). Hence, the present study sought to investigate the efficacy of FC for the diagnosis and monitoring of UC, as well as to assess the correlation of FC with other disease activity indexes. The present study included 96 consecutive patients who presented with lower gastrointestinal complaints. Patients were classified into two groups: group I (which included patients with UC) and group II (which included patients with irritable bowel syndrome); then, according to the disease activity, group I was subdivided into the following: group Ia (which included patients with active UC) and group Ib (which included only those patients of group Ia who were in the remission stage of UC). For all patients, erythrocyte sedimentation rate and C-reactive protein were determined; moreover, all patients underwent quantitative determination of calprotectin in stool samples, abdominal ultrasonography, and complete colonoscopy with biopsies for the histopathological examination to assess the disease severity by using the UC activity index according to the Mayo endoscopic and Geboes histological scores. The diagnostic validity of FC levels in correlation with Mayo Disease Activity Index (MDAI) was then investigated. FC levels showed highly significant increase in patients with active UC compared with inactive UC and irritable bowel syndrome (524.17 ± 48.0 vs. 184.48 ± 3.33 and 47.17 ± 5.32 mg/kg, respectively, P < 0.001). FC level has 100% accuracy, sensitivity, specificity, positive predictive value, and negative predictive value in distinguishing UC patients from the control group at a cutoff value of 140 mg/kg, but at a cutoff value of 223 mg/kg FC level shows 93.4% accuracy, 89.8% sensitivity, 97% specificity, 97.4% positive predictive value, and 55% negative predictive value to distinguish the active phase from the remission phase of UC. In addition, there was a statistically significant proportional correlation between FC and the MDAI, but the correlation between FC and histological inflammatory activity statistically was more significant than with MDAI (r = 0.75, P < 0.001). FC level is an accurate, noninvasive biomarker in clinical practice with high specificity and sensitivity for the diagnosis and monitoring of UC, as well as good marker for the evaluation of disease activity. Therefore, it can be used as a monitoring test to assess medical response and to predict clinical relapse of the disease.

Tu1521 Correlation Between Endocytoscopy and Histopathological Activity in the Remission Stage of Ulcerative Colitis: a Pilot Study

Tu1521 Correlation Between Endocytoscopy and Histopathological Activity in the Remission Stage of Ulcerative Colitis: a Pilot Study

Tu1522 Implementing Chromoendoscopy for Surveillance in Inflammatory Bowel Disease Does Not Increase Dysplasia Detection Compared to Conventional Colonoscopy With Random Biopsies: a Retrospective Study

Tu1522 Implementing Chromoendoscopy for Surveillance in Inflammatory Bowel Disease Does Not Increase Dysplasia Detection Compared to Conventional Colonoscopy With Random Biopsies: a Retrospective Study

Expression of inflammatory genes in the colon of ulcerative colitis patients varies with activity both at the mRNA and protein level

Ulcerative colitis (UC) is a chronic inflammatory disorder of the gastrointestinal tract involving aberrant activation of innate and adaptive immune responses. We aimed to study the expression profiles of the susceptibility gene Nod1 and selected pro- and anti- inflammatory cytokines during different stages of UC. 65 patients with mild, severe or remission stage of UC, and 22 normal colon mucosal biopsies from control individuals were included in the study for measuring the expression of nucleotide binding oligomerization 1(Nod1) and related pro- and anti-inflammatory cytokines using quantitative reverse transcription-PCR (qRT-PCR). mRNA expression levels were then correlated with severity of disease. In order to check their expression at the protein level, immunohistochemistry (IHC) was performed using Nod1, TNF-α, IFN-γ, IL-17, IL-23 and IL-13 antibodies. Significant increases in Nod1 expression with simultaneous increases in pro-inflammatory cytokines TNF-α, INF-γ, IL-17 and IL-23 mRNA levels were observed in patients with mild and severe ulcerative colitis versus control individuals. The expression levels reverted back towards normal levels in patients during remission. However, mRNA expression of selected anti-inflammatory cytokines such as IL-11 and IL-13 were substantially lower in patients compared with control samples when measured using qRT PCR. Levels of IL-10 however, although exhibiting a decreasing trend, did not attain significance. Our results show that with simultaneous increase in Nod1 expression, expression profiling of downstream inflammatory cytokines that are activated in UC patients, displayed different patterns according to the severity of the disease. These may be potential prognostic biomarkers for diagnosing UC patients.

Protein-losing enteropathy, deep venous thrombosis and pulmonary embolism in a patient with generalized inflammatory polyposis in remission stage of ulcerative colitis.

We experienced a patient with severe protein-losing enteropathy and generalized inflammatory polyposis. In addition, this case was complicated by deep venous thrombosis and pulmonary embolism. Patients with inflammatory bowel disease are at increased risk for thromboembolic events, most commonly in the setting of active colitis. However, our patient was in the remission stage. We report the occurrence of deep venous thrombosis and pulmonary embolism as a complication of inflammatory polyposis and protein-losing enteropathy in the remission stage of ulcerative colitis.

SUPERFICIAL TYPE SERRATED ADENOMA IN ULCERATIVE COLITIS RESECTED BY ENDOSCOPIC SUBMUCOSAL DISSECTION

A female patient with a 17‐year history of an entire type of ulcerative colitis (UC) showed a superficial elevated lesion in the rectum on surveillance colonoscopy. A standard colonoscopic picture showed a slightly red lesion in the background reticular mucosa in the remission stage of UC after a longstanding chronic inflammation. A chromoendoscopic picture using indigo carmine dye‐spraying showed a distinct superficial elevated lesion with slight marginal elevation of 12 mm in diameter. A magnified view showed a slightly irregular type II pit pattern (Kudo &amp; Tsuruta's classification). Ultrasonographic view using a high frequency ultrasound probe (20 MHz) showed that this lesion was confined to the intramucosal layer. As submucosal fibrosis due to previous repeated inflammations made it difficult to perform strip biopsy, an endoscopic submucosal dissection (ESD) method using a Hook knife was undertaken. A completely resected histological specimen showed a serrated adenoma.

Leukocytapheresis (LCAP) for Management of Fulminant Ulcerative Colitis with Toxic Megacolon

Leukocytapheresis (LCAP) is a method of therapeutic apheresis to remove patients' peripheral leukocytes by extracorporeal circulation. Previous studies showed that LCAP for the treatment of ulcerative colitis (UC) was more effective and had fewer adverse effects compared to high-dose steroid therapy. However, there are no reports on the application of LCAP for UC patients with toxic megacolon (TM). This study reports the effectiveness and safety of LCAP in treating patients with severe or fulminant UC with TM. Six patients were enrolled in this study and LCAP sessions were performed three times per week for 2 weeks, followed by four further times in the next 4 weeks. After completion of therapy, four patients improved in TM and went into the remission stage of UC. The average Rachmilewitz clinical activity index of these four patients improved from 19.5 to 1. The remaining two patients had to undergo colectomy, however, the symptoms had been mitigated by LCAP and the operations were completed without any problems. These results suggest that LCAP is an additional effective and safe option for TM management in preventing colectomy or for bridging to a safer operation.

Clinical significance and assessment of cytokines in various stages of ulcerative colitis.

In order to study the clinical significance and change of interleukin (IL)-1 beta and IL-10 concentration in intestinal mucosal tissues in various stage of ulcerative colitis (UC), IL-1 beta and IL10 levels were measured by enzyme linked immunosorbent assays (ELISA). Our results showed that IL-beta level caused by spontaneous secretion in the intestinal mucous tissues in active stage of ulcerative colitis was significantly higher than that in normal controls and in remission stage of ulcerative colitis (P < 0.01, P < 0.001). IL-10 level in various stage of UC was relatively lower in controls, but there was no significantly difference between the two groups. Our study suggested that higher IL-1 beta level in active might play an important role in pathogenesis of UC, and IL-10, as an anti-inflammatory cytokine, was low in active UC, suggesting that it may be a important factor contributing to the development of higher IL-1 beta level.