Use of the ulcerative colitis endoscopic index of severity and Mayo endoscopic score for predicting the therapeutic effect of mesalazine in patients with ulcerative colitis

Objective:The ulcerative colitis endoscopic index of severity(UCEIS)and the Mayo endoscopic score(MES)are developed as objective methods of evaluating endoscopic severity in patients with ulcerative colitis(UC).The aim of this study is to investigate the diagnostic accuracy of the UCEIS and MES in predicting the patient's response to mesalazine.Methods:Consecutive patients with UC who had undergone colonoscopy within 1 month before starting mesalazine between October 2011 and July 2016 were retrospectively collected at the Department of Gastroenterology,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.The median follow-up was 81 months,and all the data were analyzed in January 2021.The primary outcome was the need for step-up treatment,which included the use of corticosteroids,immunomodulatory,or surgery during admission and follow-up.Data were analyzed using the c2 or Fisher exact test,Spearman test,t-test,and ManneWhitney U test.Results:Totally,65 patients were enrolled,of whom 12(18.5%)needed step-up treatment due to nonresponse to mesalazine.The UCEIS score,MES,and the ulcerative colitis disease activity index(UCDAI)score were significantly higher in patients who had nonresponse to mesalazine(UCEIS score:6.92±0.69 vs.4.45±1.17,p<0.001;MES:2.67±0.49 vs.2.15±0.69,p=0.024;UCDAI score:9.33±1.87 vs.6.70±2.38,p=0.002).In the multivariate analysis,the UCEIS score(OR=25.65,95%CI:3.048 e45.985,p=0.003),UCDAI score(OR=1.605,95%CI:1.144e2.254,p=0.006),and C-reactive protein level(OR=1.056,95%CI:1.006e1.108,p=0.026)were independent risk factors of nonresponse.The area under the ROC curve of UCEIS was 0.95,with a sensitivity of 100%and specificity of 84.6%,a cut-off value of 6,which outperformed the MES with an area under the ROC curve of 0.70.When the UCEIS score≥6,60%of patients eventually needed step-up treatment.Conclusions:The UCEIS is a useful instrument for predicting the therapeutic effect in patients with UC treated with mesalazine.The high probability of mesalazine treatment failure and benefits of other therapies should be discussed in patients with baseline UCEIS score≥6.

Correlation of endoscopic disease severity with pediatric ulcerative colitis activity index score in children and young adults with ulcerative colitis

To investigate of pediatric ulcerative colitis activity index (PUCAI) in ulcerative colitis correlate with mucosal inflammation and endoscopic assessment of disease activity (Mayo endoscopic score).METHODSWe reviewed charts from ulcerative colitis patients who had undergone both colonoscopy over 3 years. Clinical assessment of disease severity within 35 d (either before or after) the colonoscopy were included. Patients were excluded if they had significant therapeutic interventions (such as the start of corticosteroids or immunosuppressive agents) between the colonoscopy and the clinical assessment. Mayo endoscopic score of the rectum and sigmoid were done by two gastroenterologists. Inter-observer variability in Mayo score was assessed.RESULTSWe identified 99 patients (53% female, 74% pancolitis) that met inclusion criteria. The indications for colonoscopy included ongoing disease activity (62%), consideration of medication change (10%), assessment of medication efficacy (14%), and cancer screening (14%). Based on PUCAI scores, 33% of patients were in remission, 39% had mild disease, 23% had moderate disease, and 4% had severe disease. There was “moderate-substantial” agreement between the two reviewers in assessing rectal Mayo scores (kappa = 0.54, 95%CI: 0.41-0.68).CONCLUSIONEndoscopic disease severity (Mayo score) assessed by reviewing photographs of pediatric colonoscopy has moderate inter-rater reliability, and agreement was less robust in assessing patients with mild disease activity. Endoscopic disease severity generally correlates with clinical disease severity as measured by PUCAI score. However, children with inflamed colons can have significant variation in their reported clinical symptoms. Thus, assessment of both clinical symptoms and endoscopic disease severity may be required in future clinical studies.

Prognostic scores in primary biliary cholangitis patients with advanced disease

BACKGROUND Due to the chronic progressive disease characteristics of primary biliary cholangitis(PBC),patients with advanced PBC should not be ignored.Most prognostic score studies have focused on early stage PBC.AIM To compare the prognostic value of various risk scores in advanced PBC to help PBC patients obtain more monitoring and assessment.METHODS This study considered patients diagnosed with PBC during hospitalization between 2015 and 2021.The clinical stage was primarily middle and late,and patients usually took ursodeoxycholic acid(UDCA)after diagnosis.The discriminatory performance of the scores was assessed with concordance statistics at baseline and after 1 year of UDCA treatment.Telephone follow-up was conducted to analyze the course and disease-associated outcomes.The follow-up deadline was December 31,2021.We compared the risk score indexes between those patients who reached a composite end point of death or liver transplantation(LT)and those who remained alive at the deadline.The combined performance of prognostic scores in estimating the risk of death or LT after 1 year of UDCA treatment was assessed using Cox regression analyses.Predictive accuracy was evaluated by comparing predicted and actual survival through Kaplan-Meier analyses.RESULTS We included 397 patients who were first diagnosed with PBC during hospitalization and received UDCA treatment;most disease stages were advanced.After an average of 6.4±1.4 years of follow-up,82 patients had died,and 4 patients had undergone LT.After receiving UDCA treatment for 1 year,the score with the best discrimination performance was the Mayo,with a concordance statistic of 0.740(95%confidence interval:0.690-0.791).The albumin-bilirubin,GLOBE,and Mayo scores tended to overestimate transplant-free survival.Comparing 7 years of calibration results showed that the Mayo score was the best model.CONCLUSION The Mayo,GLOBE,UK-PBC,and ALBI scores demonstrated comparable discriminating performance for advanced stage PBC.The Mayo score showed optimal discriminatory performance and excellent predictive accuracy.

Time-adjusted average Mayo endoscopic score predicts the risk of disease extent progression in distal ulcerative colitis patients

Background:Ulcerative colitis(UC)is a chronic lifelong disease.The disease extent of UC can progress over time.This study aimed to assess whether cumulative inflammatory burden(CIB)is associated with disease extension in distal UC(proctitis[E1]and left-sided colitis[E2])patients,and to develop a quantified indicator of CIB.Methods:In this retrospective study based on a prospective registry,distal UC patients receiving colonoscopies in Xijing Hospital(Xi’an,China)fromJanuary 2000 to May 2019 were studied.We developed a new score,namely the time-adjusted average Mayo endoscopic score(TA-MES),calculated as dividing the sum of the cumulative averageMES over a period of surveillance time by the length of the endoscopic examination interval,to quantify the CIB.Cox regression was used to identify other potential risk factors.Results:A total of 295 UC patients were followed for 1,487.02 patient-years.Among them,140 patients(47.5%)experienced disease extension.Multivariate analysis showed that the TA-MES was significantly associated with disease extension in E1(hazard ratio[HR],2.90;95%confidence interval[CI],1.58–5.33,P=0.001)and E2(HR,1.89;95%CI,1.16–3.09,P=0.011)patients.Other risk factors included hemoglobin of<90 g/L and appendiceal skip inflammation;the protective factors included age,E2 at diagnosis,former smoking,and 5-aminosalicylic acid dose.Otherwise,MES at diagnosis,maximal MES,and mean MES failed to estimate the risk of disease extension.Conclusion:TA-MES is a good quantified indicator of CIB and is independently associated with increased disease extension in distal UC patients.Whether the dynamic multiple scoring system could be used as a risk factor in other chronic relapsing–remitting diseases is a direction for future research.

Influence of herb-partitioned moxibustion at Qihai (CV6) and bilateral Tianshu (ST25) and Shangjuxu (ST37) acupoints on toll-like receptors 4 signaling pathways in patients with ulcerative colitis

OBJECTIVE: To evaluate the efficacy of herb-partitioned moxibustion(HPM) at Qihai(CV6), Tianshu(ST25) and Shangjuxu(ST37) acupoints in relieving symptoms and the immune regulation of HPM on the toll-like receptors 4(TLR4) signaling pathway in ulcerative colitis(UC) patients.METHODS: A randomized, single-blind study was conducted 63 patients to receive HPM or sham HPM treatment. The efficacy outcomes included scores of the Mayo, Baron, inflammatory bowel disease questionnaire(IBDQ), self-rating depression scale(SDS), self-rating anxiety scale(SAS). HE staining was used to observe the histopathological changes of the colon. The expression of inflammatory cytokines and TLR4 signaling pathway related molecules were determined by enzyme-linked immunosorbent assay and immunohistochemistry.RESULTS: Baron, SDS, SAS scores were significantly decreased in moxibustion group(P < 0.05), IBDQ score was significantly greater in the moxibustion group than in the sham moxibustion group(P < 0.05). Histopathology of mucosal biopsies showed that both two groups improved in mucosa after treatment. The expression levels of tumor necrosis factor-α, interleukin-2, interleukin-12, interferon-γ, and TLR4, lipopolysaccharide, myeloid differentiation factor 88, interleukin receptor associated kinase, tumor necrosis factor receptor associated factor 6 and nuclear factor kappa-B p65 were significantly lower in the moxibustion group than in the sham moxibustion group(P < 0.05).CONCLUSION: This study showed that HPM at Qihai(CV6), Tianshu(ST25) and Shangjuxu(ST37) acupoints is effective to relieve symptoms, anxiety, depression and improving life quality in UC patients,which may be related to the immune regulation of HPM on TLR4 signaling pathway.