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World J Gastroenterol. Nov 14, 2016; 22(42): 9324-9332
Published online Nov 14, 2016. doi: 10.3748/wjg.v22.i42.9324
Clinical relevance of endoscopic assessment of inflammation in ulcerative colitis: Can endoscopic evaluation predict outcomes?
Noor Mohammed, Venkataraman Subramanian
Noor Mohammed, Venkataraman Subramanian, Leeds Institute of Biomedical and Clinical Sciences, St James University Hospital, University of Leeds, Leeds LS2 9JT, United Kingdom
Noor Mohammed, Venkataraman Subramanian, Department of Gastroenterology, Centre for Digestive Diseases, St James University Hospital, Leeds Teaching Hospital NHS Trust, Leeds LS9 7TF, United Kingdom
Author contributions: Mohammed N wrote the first draft and edited the paper; Subramanian V conceived the idea, edited the paper.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Venkataraman Subramanian, Department of Gastroenterology, Centre for Digestive Diseases, St James University Hospital, Leeds Teaching Hospital NHS Trust, Beckett St, Beckett street, Leeds LS9 7TF, United Kingdom. v.subramanian@leeds.ac.uk
Telephone: +44-113-2433144
Received: June 28, 2016
Peer-review started: June 29, 2016
First decision: July 29, 2016
Revised: August 12, 2016
Accepted: September 6, 2016
Article in press: September 6, 2016
Published online: November 14, 2016
Processing time: 136 Days and 19.2 Hours
Abstract

Ulcerative colitis (UC) is a chronic inflammatory bowel condition characterised by a relapsing and remitting course. Symptom control has been the traditional mainstay of medical treatment. It is well known that histological inflammatory activity persists despite adequate symptom control and absence of endoscopic inflammation. Current evidence suggests that presence of histological inflammation poses a greater risk of disease relapse and subsequent colorectal cancer risk. New endoscopic technologies hold promise for developing endoscopic markers of mucosal inflammation. Achieving endoscopic and histological remission appears be the future aim of medical treatments for UC. This review article aims to evaluate the use of endoscopy as a tool in assessment of mucosal inflammation UC and its correlation with disease outcomes.

Keywords: Ulcerative colitis; Inflammation; Endoscopy; Disease activity indices; Mucosal healing

Core tip: Endoscopy is the mainstay of assessing disease activity in ulcerative colitis. Mucosal healing (MH) is an accepted end point in clinical trials. Recent data suggest that complete MH is associated with lower relapse rates and better long term outcomes. Advanced imaging techniques like high definition endoscopy, narrow band imaging, magnification endoscopy, chromoendoscopy and endomicroscopy help in detailed assessment of mucosa and the submucosal vasculature. In this review article we aim to look at the correlation between these endoscopic assessment modalities and clinical outcomes.