F. Menasci

“Mucosal healing” in ulcerative colitis:Between clinical evidence and market suggestion

In recent decades, the prominent role of endoscopy in the management of ulcerative colitis (UC) has been translated into the concept of mucosal healing (MH) as a fundamental therapeutic end-point. This is partially the consequence of growing evidence of a positive prognostic role of MH on the disease course and partially due to market cues indicating a higher rate of MH in patients treated by novel potent biologic agents. The aim of the present review is to clarify the current knowledge of MH in UC, analyzing the definition, the putative prognostic role and the association of MH with the current drugs used to treat UC patients. Because solid data about the management of UC patients based solely on the healing of the mucosa are not yet available, a tailored approach for individual patients thatconsiders the natural history of UC and the presence of prognostic indicators of aggressive disease is desirable. Consequently, unnecessary examinations and treatment would be avoided and restricted to UC patients who require the maximum amount of effort to affect the disease course in the short and long term.

Disease Extension Matters in Endoscopic Scores: UCEIS Calculated as a Sum of the Single Colonic Segments Performed Better than Regular UCEIS in Outpatients with Ulcerative Colitis

We have read with great interest the article by Corte et al .1 Indeed, the Ulcerative Colitis Endoscopic Index of Severity [UCEIS] provides an accurate evaluation of the mucosal appearance together with high intra- and inter-observer agreement.2,3 Nonetheless, it considers just the more inflamed colonic segment, not including the disease extension. This could from one side allow the calculation of the score even from a rectum-sigmoidoscopy, thus avoiding complete colonoscopy that may be contraindicated in particular settings such as acute severe ulcerative colitis [UC]. From the other side, this may represent a potential limitation, in particular in outpatients where total colonoscopy may be the most appropriate examination.4 We retrospectively analysed data of 80 UC outpatients, between 2009 and 2013, at S. Andrea Hospital in Rome, Italy. We included patients who had, within a 1-month period, …