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Vol.17 No.1
January, 2023
Frequency : Bimonthly
pISSN 1976-2283
eISSN 2005-1212 
Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut atnd Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. +MORE
| Yong Chan Lee |
Professor of Medicine Director, Gastrointestinal Research Laboratory Veterans Affairs Medical Center, Univ. California San Francisco San Francisco, USA |
| Jong Pil Im | Seoul National University College of Medicine, Seoul, Korea |
| Robert S. Bresalier | University of Texas M. D. Anderson Cancer Center, Houston, USA |
| Steven H. Itzkowitz | Mount Sinai Medical Center, NY, USA |
All papers submitted to Gut and Liver are reviewed by the editorial team before being sent out for an external peer review to rule out papers that have low priority, insufficient originality, scientific flaws, or the absence of a message of importance to the readers of the Journal. A decision about these papers will usually be made within two or three weeks.
The remaining articles are usually sent to two reviewers. It would be very helpful if you could suggest a selection of reviewers and include their contact details. We may not always use the reviewers you recommend, but suggesting reviewers will make our reviewer database much richer; in the end, everyone will benefit. We reserve the right to return manuscripts in which no reviewers are suggested.
The final responsibility for the decision to accept or reject lies with the editors. In many cases, papers may be rejected despite favorable reviews because of editorial policy or a lack of space. The editor retains the right to determine publication priorities, the style of the paper, and to request, if necessary, that the material submitted be shortened for publication.
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Eun Ae Kang 
Correspondence to: Eun Ae Kang
ORCID https://orcid.org/0000-0003-0220-937X
E-mail cheerea@gmail.com
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Gut Liver 2022;16(3):487-488. https://doi.org/10.5009/gnl210490
Published online January 7, 2022, Published date May 15, 2022
Copyright © Gut and Liver.
A recently published retrospective study by Shin
Endoscopic remission, also known as mucosal healing, is considered a therapeutic goal for UC.2 However, CR based on patient-reported outcomes is inconsistent with endoscopic findings. A previzous study reported that only half of these patients with CR based on patient-reported outcomes had endoscopic remission.3 There have been several studies on the effects of endoscopic residual inflammation in UC. Previous studies have reported that irritable bowel syndrome-like symptoms are associated with residual colonic inflammation in UC patients in CR.4,5 One study reported that residual short-segment distal inflammation is not a risk factor for major relapses, provided that endoscopic remission is achieved in the proximal colon.6
I would like to raise a few questions to the authors of this study. First, the severity of nonrectal inflammation and rectal inflammation was significantly different (p<0.001) between the groups and there was a wide variation in Ulcerative Colitis Segmental Endoscopic Index (UCSEI) scores. A worse prognosis may be attributable to the severity of endoscopic condition, rather than the distribution of residual rectal inflammation. According to the results presented in Table 2, UCSEI was a significant predictor of poor outcomes in the univariate analysis but not in the multivariate analysis; this result is likely due to the small sample size of this study.
Second, it may be beneficial to discuss the number of patients using topical 5-aminosalicylic acid (5-ASA) suppositories in the nonrectal and rectal inflammation groups since residual rectal inflammation may be affected by the use of topical 5-ASA formulations. Poor adherence and intolerance to 5-ASA are associated with a risk of adverse clinical outcomes.7,8 According to the data presented in Supplementary Table 1, there was no between-group difference in the use of medications, but the use of thiopurine or biologics was higher in the rectal inflammation group than in the endoscopic remission or nonrectal inflammation group. It is possible that the rectal inflammation group maintained CR status because the patients used highly effective medications such as immunomodulators or biologics.9,10 Therefore, the possibility of bias cannot be ruled out.
Third, Supplementary Fig. 1 shows the changes in the distribution of residual inflammation according to the distribution of inflammation in UC patients in CR. However, the figure fails to show if clinical outcomes differed according to the change of distribution: from rectal inflammation (n=51) to endoscopic remission (n=16), nonrectal inflammation (n=2), or sustained rectal inflammation (n=33).
In conclusion, as the authors noted, well-designed prospective studies are needed to support the findings of this study. With stronger evidence, customized treatment according to a patient’s residual rectal inflammation status will be possible.
No potential conflict of interest relevant to this article was reported.
Gut and Liver 2022; 16(3): 487-488
Published online May 15, 2022 https://doi.org/10.5009/gnl210490
Copyright © Gut and Liver.
Eun Ae Kang
Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
Correspondence to:Eun Ae Kang
ORCID https://orcid.org/0000-0003-0220-937X
E-mail cheerea@gmail.com
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
A recently published retrospective study by Shin
Endoscopic remission, also known as mucosal healing, is considered a therapeutic goal for UC.2 However, CR based on patient-reported outcomes is inconsistent with endoscopic findings. A previzous study reported that only half of these patients with CR based on patient-reported outcomes had endoscopic remission.3 There have been several studies on the effects of endoscopic residual inflammation in UC. Previous studies have reported that irritable bowel syndrome-like symptoms are associated with residual colonic inflammation in UC patients in CR.4,5 One study reported that residual short-segment distal inflammation is not a risk factor for major relapses, provided that endoscopic remission is achieved in the proximal colon.6
I would like to raise a few questions to the authors of this study. First, the severity of nonrectal inflammation and rectal inflammation was significantly different (p<0.001) between the groups and there was a wide variation in Ulcerative Colitis Segmental Endoscopic Index (UCSEI) scores. A worse prognosis may be attributable to the severity of endoscopic condition, rather than the distribution of residual rectal inflammation. According to the results presented in Table 2, UCSEI was a significant predictor of poor outcomes in the univariate analysis but not in the multivariate analysis; this result is likely due to the small sample size of this study.
Second, it may be beneficial to discuss the number of patients using topical 5-aminosalicylic acid (5-ASA) suppositories in the nonrectal and rectal inflammation groups since residual rectal inflammation may be affected by the use of topical 5-ASA formulations. Poor adherence and intolerance to 5-ASA are associated with a risk of adverse clinical outcomes.7,8 According to the data presented in Supplementary Table 1, there was no between-group difference in the use of medications, but the use of thiopurine or biologics was higher in the rectal inflammation group than in the endoscopic remission or nonrectal inflammation group. It is possible that the rectal inflammation group maintained CR status because the patients used highly effective medications such as immunomodulators or biologics.9,10 Therefore, the possibility of bias cannot be ruled out.
Third, Supplementary Fig. 1 shows the changes in the distribution of residual inflammation according to the distribution of inflammation in UC patients in CR. However, the figure fails to show if clinical outcomes differed according to the change of distribution: from rectal inflammation (n=51) to endoscopic remission (n=16), nonrectal inflammation (n=2), or sustained rectal inflammation (n=33).
In conclusion, as the authors noted, well-designed prospective studies are needed to support the findings of this study. With stronger evidence, customized treatment according to a patient’s residual rectal inflammation status will be possible.
No potential conflict of interest relevant to this article was reported.
pISSN 1976-2283
eISSN 2005-1212
Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut atnd Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. +MORE
| Yong Chan Lee |
Professor of Medicine Director, Gastrointestinal Research Laboratory Veterans Affairs Medical Center, Univ. California San Francisco San Francisco, USA |
| Jong Pil Im | Seoul National University College of Medicine, Seoul, Korea |
| Robert S. Bresalier | University of Texas M. D. Anderson Cancer Center, Houston, USA |
| Steven H. Itzkowitz | Mount Sinai Medical Center, NY, USA |
All papers submitted to Gut and Liver are reviewed by the editorial team before being sent out for an external peer review to rule out papers that have low priority, insufficient originality, scientific flaws, or the absence of a message of importance to the readers of the Journal. A decision about these papers will usually be made within two or three weeks.
The remaining articles are usually sent to two reviewers. It would be very helpful if you could suggest a selection of reviewers and include their contact details. We may not always use the reviewers you recommend, but suggesting reviewers will make our reviewer database much richer; in the end, everyone will benefit. We reserve the right to return manuscripts in which no reviewers are suggested.
The final responsibility for the decision to accept or reject lies with the editors. In many cases, papers may be rejected despite favorable reviews because of editorial policy or a lack of space. The editor retains the right to determine publication priorities, the style of the paper, and to request, if necessary, that the material submitted be shortened for publication.
