Progress of ulcerative colitis patients during the COVID-19 pandemic

BACKGROUND We have previously demonstrated that the first wave of the coronavirus disease 2019(COVID-19)pandemic caused exacerbations in ulcerative colitis(UC)patients,probably through psychological and physical stress.However,successive waves of the COVID-19 pandemic continuously followed the first.The effects of this chronic stress on the disease condition in UC patients are of interest.AIM To clarify the effect of chronic stress from COVID-19 on disease condition in patients aggravated after the first wave.METHODS Our previous study investigated 289 consecutive UC outpatients treated in one center during March and April 2020,the period of the first wave of the COVID-19 pandemic.In this study,an identical group of 289 UC patients was evaluated using UC-disease activity index(UC-DAI),endoscopic mucosal appearance score,and Matts pathological grade scoring.RESULTS Of the 289 UC patients included in the study in 2020,10 patients dropped out as of 2021 and another 11 patients dropped out as of 2022,making three groups for 2020,2021 and 2022.No significant differences in characteristics were found among the three groups.UC-DAI scores had aggravated during the period of the first wave of the COVID-19 pandemic,but significantly recovered in 2021 and remained stable in 2022.Matts grade scores significantly recovered in 2021 from those in 2020 and remained stable in 2022.CONCLUSION Disease activity of UC patients recovered in 2021 and remained stable in 2022,aggravated by the stress of the first wave of COVID-19 in 2020 despite persistence of the pandemic.

Shear wave elastography in hepatitis C patients before and after antiviral therapy

AIM To investigate shear wave(SW) propagation velocity in patients with untreated hepatitis C and patients with sustained virological response(SVR). METHODS A total of 136 hepatitis C patients [85 patients who had not received antiviral therapy(na?ve group) and 51 patients who had received antiviral therapy and subsequently achieved SVR of at least 24 wk(SVR group)] and 58 healthy volunteers and outpatients without liver disease(control group) underwent evaluation of liver stiffness by SW elastography(SWE). Various parameters were evaluated in the chronic hepatitis C patients at the time of SWE.RESULTS SW propagation velocity(Vs) was 1.23 ± 0.14 m/s in the control group, 1.56 ± 0.32 m/s in the SVR group, and 1.69 ± 0.31 m/s in the na?ve group. Significant differences were seen between the control group and the SVR group(P = 0.0000) and between the SVR group and the na?ve group(P = 0.01417). All four fibrosis markers were higher in the na?ve group than in the SVR group. In the na?ve group, Vs was positively correlated with alanine aminotransferase(ALT)(r = 0.5372), α feto protein(AFP)(r = 0.4389), type Ⅳ collagen(r = 0.5883), procollagen Ⅲ peptide(P-Ⅲ-P)(r = 0.4140), hyaluronic acid(r = 0.4551), and Mac-2 binding protein glycosylation isomer(M2BPGi)(r = 0.6092) and negatively correlated with albumin(r =-0.4289), platelets(r =-0.5372), and prothrombinactivity(r =-0.5235). On multiple regression analysis, Vs was the most strongly correlated with ALT(standard partial regression std β = 0.4039, P = 0.00000). In the SVR group, Vs was positively correlated with AFP(r = 0.6977), type IV collagen(r = 0.5228), P-Ⅲ-P(r = 0.5812), hyaluronic acid(r = 0.5189), and M2BPGi(r = 0.6251) and negatively correlated with albumin(r =-0.4283), platelets(r =-0.4842), and prothrombin activity(r =-0.4771). On multiple regression analysis, Vs was strongly correlated with AFP(standard partial regression std β = 0.5953, P = 0.00000) and M2BPGi(standard partial regression std β = 0.2969, P = 0.03363).CONCLUSION In hepatitis C patients, liver stiffness is higher in treatment-na?ve patients than in those showing SVR. SWE may be a predictor of hepatocarcinogenesis in SVR patients.

Study of pruritus in chronic hepatitis C patients

AIM:To investigate the occurrence and severity of pruritus in chronic hepatitis C patients treated with or without interferon(IFN)therapy.METHODS:A total of 89 patients with chronic hepatitis C and 55 control(non-hepatitis)patients were asked to rate their experience of diurnal and nocturnal pruritus in the preceding week using a visual analogue scale(VAS)and a five-point scale,respectively.Blood samples were taken and serum thymus and activationregulated chemokine(TARC)levels were measured by enzyme-linked immunosorbent assay.RESULTS:A significantly greater proportion of chronic hepatitis C patients experienced nocturnal pruritus compared with control(58.4%vs 5.5%,P<0.0001).Chronic hepatitis C patients also had more severe pruritus compared with control patients,indicated by the higher mean VAS scores in both the IFN-treated and non-IFN-treated groups.In particular,patients who received combined peginterferon alfa-2b and ribavirin had significantly higher mean VAS scores than those receiving peginterferon alfa-2a or no IFN treatment.SerumTARC levels did not correlate with pruritus scores,and no significant differences in TARC levels were observed between the IFN-treated and non-IFN-treated groups.CONCLUSION:Patients with chronic hepatitis C experience pruritus more than those without.Serum TARC levels do not correlate with pruritus severity in chronic hepatitis C patients.

Post-colonoscopy colorectal cancer rate in the era of highdefinition colonoscopy

AIM To investigate the post-colonoscopy colorectal cancer(PCCRC) rate for high-definition(HD) colonoscopy compared with that for standard-definition colonoscopy reported previously.METHODS Using medical records at Sano Hospital(SH) and Dokkyo Medical University Koshigaya Hospital(DMUKH), we retrospectively obtained data on consecutive patients diagnosed as having CRC between January 2010 andDecember 2015. The definition of PCCRC was diagnosis of CRC between 7 and 36 mo after initial high-definition colonoscopy that had detected no cancer, and patients were divided into a PCCRC group and a non-PCCRC group. The primary outcome was the rate of PCCRC for HD colonoscopy. The secondary outcomes were factors associated with PCCRC and possible reason for occurrence of early and advanced PCCRC.RESULTS Among 892 CRC patients, 11 were diagnosed as having PCCRC and 881 had non-PCCRC. The PCCRC rate was 1.7%(8/471) at SH and 0.7%(3/421) at DMUKH. In comparison with the non-PCCRC group, the PCCRC group had a significantly higher preponderance of smaller tumors(39 mm vs 19 mm, P = 0.002), a shallower invasion depth(T1 rate, 25.4% vs 63.6%, P = 0.01), a non-polypoid macroscopic appearance(39.0% vs 85.7%, P = 0.02) and an earlier stage(59.7% vs 90.9%, P = 0.03). Possible reasons for PCCRC were "missed or new" in 9 patients(82%), "incomplete resection" in 1(9%), and "inadequate examination'" in 1(9%). Among 9 "missed or new" PCCRC, the leading cause was non-polypoid shape for early PCCRC and blinded location for advanced PCCRC.CONCLUSION The PCCRC rate for HD colonoscopy was 0.7%-1.7%, being lower than that for standard-definition colonoscopy(1.8%-9.0%) reported previously employing the same methodology.

COVID-19 pandemic and exacerbation of ulcerative colitis

BACKGROUND In 2020,the world faced the unprecedented crisis of coronavirus disease 2019(COVID-19).Besides the infection and its consequences,COVID-19 also resulted in anxiety and stress resulting from severe restrictions on economic and social activities,including for patients with ulcerative colitis(UC).Fresh acute stress exerts stronger influences than continuous stress on UC patients.We therefore hypothesized that the first wave of the COVID-19 pandemic would have serious effects on UC patients and performed this retrospective control study.AIM To determine whether the first wave of the COVID-19 pandemic would have serious effects on UC patients included in a retrospective controlled study.METHODS A total of 289 consecutive UC outpatients seen in March and April 2020 were included in this study.Modified UC disease activity index(UC-DAI)scores on the day of entry and at the previous visit were compared.An increase of≥2 was considered to indicate exacerbation.The exacerbation rate was also compared with that in 256 consecutive control patients independently included in the study from the same period of the previous year in the same manner.RESULTS No significant differences in patient characteristics or pharmacotherapies before entry were seen between the groups.Mean UC-DAI score was significantly higher in subjects during the first wave of COVID-19(0.67+0.07)compared to the previous visit(0.26+0.04;P=0.0000).The exacerbation rate was significantly increased during the first wave of COVID-19,as compared with the previous year(15.9%[46/289]vs 8.9%[23/256];P=0.0151).CONCLUSION This study demonstrated that the COVID-19 pandemic caused exacerbations in UC patients,probably through psychological and physical stress.

Non-improvement of atrophic gastritis in cases of gastric cancer after successful Helicobacter pylori eradication therapy

BACKGROUND Helicobacter pylori(H.pylori)infection is closely related to the development of gastric cancer(GC).However,GC can develop even after H.pylori eradication.Therefore,it would be extremely useful if GC could be predicted after eradication.The Kyoto classification score for gastritis(GA)is closely related to cancer risk.However,how the score for GC changes after eradication before onset is not well understood.AIM To investigate the characteristics of the progression of Kyoto classification scores for GC after H.pylori eradication.METHODS Eradication of H.pylori was confirmed in all patients using either the urea breath test or the stool antigen test.The Kyoto classification score of GC patients was evaluated by endoscopy at the time of event onset and three years earlier.In ad-dition,the modified atrophy score was evaluated and compared between the GC group and the control GA group.RESULTS In total,30 cases of early GC and 30 cases of chronic GA were evaluated.The pathology of the cancer cases was differentiated adenocarcinoma,except for one case of undifferentiated adenocarcinoma.The total score of the Kyoto classifi-cation was significantly higher in the GC group both at the time of cancer onset and three years earlier(4.97 vs 3.73,P=0.0034;4.2 vs 3.1,P=0.0035,respectively).The modified atrophy score was significantly higher in the GC group both at the time of cancer onset and three years earlier and was significantly improved only in the GA group(5.3 vs 5.3,P=0.5;3.73 vs 3.1,P=0.0475,respectively).CONCLUSION The course of the modified atrophy score is useful for predicting the onset of GC after eradication.Patients with severe atrophy after H.pylori eradication require careful monitoring.