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Doubts about mucosal healing in ulcerative colitis
European Journal of Internal Medicine 23 (2012) e113
Contents lists available at SciVerse ScienceDirect
European Journal of Internal Medicine journal homepage: www.elsevier.com/locate/ejim
Letters to the editor Doubts about mucosal healing in ulcerative colitis Keywords: Mucosal healing Clinical remission Ulcerative colitis
Our study [1] shows the efficacy of azathioprine and mercaptopurine in achieving mucosal healing in patients who clinically respond to thiopurine immunosuppressants in the long term. And the group of patients did not achieve mucosal healing was lower time in clinical remission. This finding indicates the potential importance of intensifying treatment in this group of patients with ulcerative colitis. Conflict of interest statement
Dear Sir, I would like to thank the comments made about our recent paper [1] by Filik [2]. Mucosal healing is now considered a relevant end point in clinical trials in ulcerative colitis. There is also growing evidence that mucosal healing is an important treatment goal in clinical practice as it is associated with improved long-term outcomes (lower risk of relapse, a reduced risk of colorectal cancer, a decreased need for surgery, and improved quality of life) [3]. But mucosal healing is still uncertain how it should be used in clinical practice. Further studies are needed to develop standardized endoscopic scoring systems for mucosal healing that will be validated in prospective clinical trials evaluating long-term outcomes for ulcerative colitis. In the next years, it is likely that endoscopy will be increasingly used in the future to guide therapeutic decision making. Now, there is potential to use biomarkers to assess mucosal healing following medical therapy and to predict the likelihood of relapse. In a recent review conducted by Lewis J [4] concludes that the Creactive protein test has a low sensitivity in detection of ulcerative colitis. The abilities of C-reactive protein to identify patients who are most likely to undergo disease relapse have also been examined. Bitton et al. [5] examined markers of relapse of 74 patients with clinically and endoscopically quiescent ulcerative colitis (27 relapsed during the follow-up period). Although the identification of basal plasmacytosis in rectal biopsy samples was associated with relapse, increased levels of C-reactive protein was not. And Schoepfer et al. [6] showed that fecal calprotectin correlated closest with endoscopic disease activity, followed by Clinical Activity Index, C-reactive protein , and blood leukocytes. So C-reactive protein does not seem to be an adequate biomarker for the assessment of endoscopic disease activity in ulcerative colitis. While, the fecal biomarkers can be used to assess mucosal healing without the need for invasive testing.
We, Natalia López-Palacios and Juan Luís Mendoza Hernández, declare that we have no propietary, financial, professional or other personal interest of any nature or kind in any product, service and/ or company that could be construed as influencing the position presented in, the letter to editor entitled “Clinical remission or mucosal healing: a therapeutic dilemma of ulcerative colitis”, Author: Natalia López Palacios. References [1] López-Palacios N, Mendoza JL, Taxonera C, Lana R, Esteban JM, Díaz-Rubio M. Mucosal healing for predicting clinical outcome in patients with ulcerative colitis using thiopurines in monotherapy. EJIM 2011;22:621–5. [2] Filik L. Clinical remission or mucosal healing: a therapeutic dilemma of ulcerative colitis. EJIM January 2012. [3] Lichtenstein GR, Rutgeerts P. Importance of mucosal healing in ulcerative colitis. Inflamm Bowel Dis 2010;16:338–46. [4] Lewis JD. The utility of biomarkers in the diagnosis and therapy of inflammatory bowel disease. Gastroenterology 2011;140:1817–26. [5] Bitton A, Peppercorn MA, Antonioli DA, Niles JL, Shah S, Bousvaros A, et al. Clinical, biological, and histologic parameters as predictors of relapse in ulcerative colitis. Gastroenterology 2001;120:13–20. [6] Schoepfer AM, Beglinger C, Straumann A, Trummler M, Renzulli P, Seibold F. Ulcerative colitis: correlation of the Rachmilewitz endoscopic activity index with fecal calprotectin, clinical activity, c-reactive protein, and blood leukocytes. Inflamm Bowel Dis 2009;15:1851–8.
Natalia López-Palacios⁎ Juan L. Mendoza Hernandez Department of Gastroenterology, Hospital Clínico San Carlos, Madrid, Spain ⁎Corresponding author at: Calle Profesor Martín Lagos s/n 28040 Madrid. Spain. Tel.: +34 913303713; fax: +34 913303785. E-mail address: [email protected] (N. López-Palacios).
0953-6205/$ – see front matter. Published by Elsevier B.V. on behalf of European Federation of Internal Medicine. doi:10.1016/j.ejim.2012.01.006
9 January 2012
Contents lists available at SciVerse ScienceDirect
European Journal of Internal Medicine journal homepage: www.elsevier.com/locate/ejim
Letters to the editor Doubts about mucosal healing in ulcerative colitis Keywords: Mucosal healing Clinical remission Ulcerative colitis
Our study [1] shows the efficacy of azathioprine and mercaptopurine in achieving mucosal healing in patients who clinically respond to thiopurine immunosuppressants in the long term. And the group of patients did not achieve mucosal healing was lower time in clinical remission. This finding indicates the potential importance of intensifying treatment in this group of patients with ulcerative colitis. Conflict of interest statement
Dear Sir, I would like to thank the comments made about our recent paper [1] by Filik [2]. Mucosal healing is now considered a relevant end point in clinical trials in ulcerative colitis. There is also growing evidence that mucosal healing is an important treatment goal in clinical practice as it is associated with improved long-term outcomes (lower risk of relapse, a reduced risk of colorectal cancer, a decreased need for surgery, and improved quality of life) [3]. But mucosal healing is still uncertain how it should be used in clinical practice. Further studies are needed to develop standardized endoscopic scoring systems for mucosal healing that will be validated in prospective clinical trials evaluating long-term outcomes for ulcerative colitis. In the next years, it is likely that endoscopy will be increasingly used in the future to guide therapeutic decision making. Now, there is potential to use biomarkers to assess mucosal healing following medical therapy and to predict the likelihood of relapse. In a recent review conducted by Lewis J [4] concludes that the Creactive protein test has a low sensitivity in detection of ulcerative colitis. The abilities of C-reactive protein to identify patients who are most likely to undergo disease relapse have also been examined. Bitton et al. [5] examined markers of relapse of 74 patients with clinically and endoscopically quiescent ulcerative colitis (27 relapsed during the follow-up period). Although the identification of basal plasmacytosis in rectal biopsy samples was associated with relapse, increased levels of C-reactive protein was not. And Schoepfer et al. [6] showed that fecal calprotectin correlated closest with endoscopic disease activity, followed by Clinical Activity Index, C-reactive protein , and blood leukocytes. So C-reactive protein does not seem to be an adequate biomarker for the assessment of endoscopic disease activity in ulcerative colitis. While, the fecal biomarkers can be used to assess mucosal healing without the need for invasive testing.
We, Natalia López-Palacios and Juan Luís Mendoza Hernández, declare that we have no propietary, financial, professional or other personal interest of any nature or kind in any product, service and/ or company that could be construed as influencing the position presented in, the letter to editor entitled “Clinical remission or mucosal healing: a therapeutic dilemma of ulcerative colitis”, Author: Natalia López Palacios. References [1] López-Palacios N, Mendoza JL, Taxonera C, Lana R, Esteban JM, Díaz-Rubio M. Mucosal healing for predicting clinical outcome in patients with ulcerative colitis using thiopurines in monotherapy. EJIM 2011;22:621–5. [2] Filik L. Clinical remission or mucosal healing: a therapeutic dilemma of ulcerative colitis. EJIM January 2012. [3] Lichtenstein GR, Rutgeerts P. Importance of mucosal healing in ulcerative colitis. Inflamm Bowel Dis 2010;16:338–46. [4] Lewis JD. The utility of biomarkers in the diagnosis and therapy of inflammatory bowel disease. Gastroenterology 2011;140:1817–26. [5] Bitton A, Peppercorn MA, Antonioli DA, Niles JL, Shah S, Bousvaros A, et al. Clinical, biological, and histologic parameters as predictors of relapse in ulcerative colitis. Gastroenterology 2001;120:13–20. [6] Schoepfer AM, Beglinger C, Straumann A, Trummler M, Renzulli P, Seibold F. Ulcerative colitis: correlation of the Rachmilewitz endoscopic activity index with fecal calprotectin, clinical activity, c-reactive protein, and blood leukocytes. Inflamm Bowel Dis 2009;15:1851–8.
Natalia López-Palacios⁎ Juan L. Mendoza Hernandez Department of Gastroenterology, Hospital Clínico San Carlos, Madrid, Spain ⁎Corresponding author at: Calle Profesor Martín Lagos s/n 28040 Madrid. Spain. Tel.: +34 913303713; fax: +34 913303785. E-mail address: [email protected] (N. López-Palacios).
0953-6205/$ – see front matter. Published by Elsevier B.V. on behalf of European Federation of Internal Medicine. doi:10.1016/j.ejim.2012.01.006
9 January 2012