Article Search
검색
검색 팝업 닫기

Metrics

Help

  • 1. Aims and Scope

    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

  • 2. Editorial Board

    Editor-in-Chief + MORE

    Editor-in-Chief
    Yong Chan Lee Professor of Medicine
    Director, Gastrointestinal Research Laboratory
    Veterans Affairs Medical Center, Univ. California San Francisco
    San Francisco, USA

    Deputy Editor

    Deputy Editor
    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
  • 3. Editorial Office
  • 4. Articles
  • 5. Instructions for Authors
  • 6. File Download (PDF version)
  • 7. Ethical Standards
  • 8. Peer Review

    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.

Search

Search

Year

to

Article Type

Letter to the Editor

Split Viewer

The Prognostic Value of Residual Nonrectal Inflammation in Ulcerative Colitis

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

Received: October 23, 2021; Revised: November 2, 2021; Accepted: November 3, 2021

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

Published online May 15, 2022 https://doi.org/10.5009/gnl210490

Copyright © Gut and Liver.

To the Editor:

A recently published retrospective study by Shin et al.1 evaluated the prognosis of ulcerative colitis (UC) patients in clinical remission (CR) according to the distribution and severity of endoscopically detected residual inflammation. Patients who achieved endoscopic remission or residual nonrectal inflammation with patch distribution had better clinical outcomes (progression-free survival, progression-free survival) than patients with residual rectal inflammation. Multivariate analysis identified only rectal inflammation as being associated with a higher risk of poor outcomes. This study was the first to evaluate residual inflammation patterns in UC patients in CR and compare the effects of residual inflammation patterns on progression-free survival.

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.

  1. Shin J, Kong SM, Kim TJ, et al. Clinical significance of residual nonrectal inflammation in ulcerative colitis patients in clinical remission. Gut Liver 2021;15:401-409.
    Pubmed KoreaMed CrossRef
  2. Hibi T, Naganuma M, Oda E, et al. Predictive factors for achievement of mucosal healing by budesonide 2-mg foam in ulcerative colitis: a pooled analysis of data from two clinical trials. Intest Res 2020;18:56-68.
    Pubmed KoreaMed CrossRef
  3. Dulai PS, Singh S, Jairath V, et al. Prevalence of endoscopic improvement and remission according to patient-reported outcomes in ulcerative colitis. Aliment Pharmacol Ther 2020;51:435-445.
    Pubmed KoreaMed CrossRef
  4. Ishihara S, Kawashima K, Fukuba N, et al. irritable bowel syndrome-like symptoms in ulcerative colitis patients in clinical remission: association with residual colonic inflammation. Digestion 2019;99:46-51.
    Pubmed CrossRef
  5. Fukuba N, Ishihara S, Tada Y, et al. Prevalence of irritable bowel syndrome-like symptoms in ulcerative colitis patients with clinical and endoscopic evidence of remission: prospective multicenter study. Scand J Gastroenterol 2014;49:674-680.
    Pubmed CrossRef
  6. Asonuma K, Kobayashi T, Nakano M, et al. Residual short-segment distal inflammation has no significant impact on the major relapse of extensive ulcerative colitis. Inflamm Bowel Dis 2022;28:200-207.
    Pubmed CrossRef
  7. Mizuno S, Ono K, Mikami Y, et al. 5-Aminosalicylic acid intolerance is associated with a risk of adverse clinical outcomes and dysbiosis in patients with ulcerative colitis. Intest Res 2020;18:69-78.
    Pubmed KoreaMed CrossRef
  8. Sood A, Ahuja V, Midha V, et al. Colitis and Crohn's Foundation (India) consensus statements on use of 5-aminosalicylic acid in inflammatory bowel disease. Intest Res 2020;18:355-378.
    Pubmed KoreaMed CrossRef
  9. Hibi T, Kamae I, Pinton P, et al. Efficacy of biologic therapies for biologic-naïve Japanese patients with moderately to severely active ulcerative colitis: a network meta-analysis. Intest Res 2021;19:53-61.
    Pubmed KoreaMed CrossRef
  10. Ooi CJ, Hilmi I, Banerjee R, et al. Best practices on immunomodulators and biologic agents for ulcerative colitis and Crohn's disease in Asia. Intest Res 2019;17:285-310.
    Pubmed KoreaMed CrossRef

Article

Letter to the Editor

Gut and Liver 2022; 16(3): 487-488

Published online May 15, 2022 https://doi.org/10.5009/gnl210490

Copyright © Gut and Liver.

The Prognostic Value of Residual Nonrectal Inflammation in Ulcerative Colitis

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

Received: October 23, 2021; Revised: November 2, 2021; Accepted: November 3, 2021

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.

Body

To the Editor:

A recently published retrospective study by Shin et al.1 evaluated the prognosis of ulcerative colitis (UC) patients in clinical remission (CR) according to the distribution and severity of endoscopically detected residual inflammation. Patients who achieved endoscopic remission or residual nonrectal inflammation with patch distribution had better clinical outcomes (progression-free survival, progression-free survival) than patients with residual rectal inflammation. Multivariate analysis identified only rectal inflammation as being associated with a higher risk of poor outcomes. This study was the first to evaluate residual inflammation patterns in UC patients in CR and compare the effects of residual inflammation patterns on progression-free survival.

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.

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

References

  1. Shin J, Kong SM, Kim TJ, et al. Clinical significance of residual nonrectal inflammation in ulcerative colitis patients in clinical remission. Gut Liver 2021;15:401-409.
    Pubmed KoreaMed CrossRef
  2. Hibi T, Naganuma M, Oda E, et al. Predictive factors for achievement of mucosal healing by budesonide 2-mg foam in ulcerative colitis: a pooled analysis of data from two clinical trials. Intest Res 2020;18:56-68.
    Pubmed KoreaMed CrossRef
  3. Dulai PS, Singh S, Jairath V, et al. Prevalence of endoscopic improvement and remission according to patient-reported outcomes in ulcerative colitis. Aliment Pharmacol Ther 2020;51:435-445.
    Pubmed KoreaMed CrossRef
  4. Ishihara S, Kawashima K, Fukuba N, et al. irritable bowel syndrome-like symptoms in ulcerative colitis patients in clinical remission: association with residual colonic inflammation. Digestion 2019;99:46-51.
    Pubmed CrossRef
  5. Fukuba N, Ishihara S, Tada Y, et al. Prevalence of irritable bowel syndrome-like symptoms in ulcerative colitis patients with clinical and endoscopic evidence of remission: prospective multicenter study. Scand J Gastroenterol 2014;49:674-680.
    Pubmed CrossRef
  6. Asonuma K, Kobayashi T, Nakano M, et al. Residual short-segment distal inflammation has no significant impact on the major relapse of extensive ulcerative colitis. Inflamm Bowel Dis 2022;28:200-207.
    Pubmed CrossRef
  7. Mizuno S, Ono K, Mikami Y, et al. 5-Aminosalicylic acid intolerance is associated with a risk of adverse clinical outcomes and dysbiosis in patients with ulcerative colitis. Intest Res 2020;18:69-78.
    Pubmed KoreaMed CrossRef
  8. Sood A, Ahuja V, Midha V, et al. Colitis and Crohn's Foundation (India) consensus statements on use of 5-aminosalicylic acid in inflammatory bowel disease. Intest Res 2020;18:355-378.
    Pubmed KoreaMed CrossRef
  9. Hibi T, Kamae I, Pinton P, et al. Efficacy of biologic therapies for biologic-naïve Japanese patients with moderately to severely active ulcerative colitis: a network meta-analysis. Intest Res 2021;19:53-61.
    Pubmed KoreaMed CrossRef
  10. Ooi CJ, Hilmi I, Banerjee R, et al. Best practices on immunomodulators and biologic agents for ulcerative colitis and Crohn's disease in Asia. Intest Res 2019;17:285-310.
    Pubmed KoreaMed CrossRef
Gut and Liver

Vol.16 No.3
May, 2022

pISSN 1976-2283
eISSN 2005-1212

qrcode
qrcode

Share this article on :

  • line

Popular Keywords

Gut and LiverQR code Download
qr-code

Editorial Office