Intest Res.  2022 Jul;20(3):297-302. 10.5217/ir.2021.00099.

Endoscopy for assessment of mucosal healing in ulcerative colitis: time bound or response guided?

• Sood A
• Mahajan R
• Singh A
• Midha V
• Mehta V

• KMID: 2531983
• DOI: http://doi.org/10.5217/ir.2021.00099

Abstract

The timing of colonoscopy in patients with active ulcerative colitis (UC) lacks coherence. The published guidelines and recommendations advocate time-bound colonoscopy in patients with active UC to assess for mucosal healing. However, the practice of performing colonoscopies at fixed time frames lacks reasoning. The time to achieve mucosal healing in UC is not uniform across the patient populations and is influenced by the disease severity and efficacy and time to therapeutic response of the drugs being used. Additionally, with the availability of sensitive noninvasive inflammatory biomarkers such as fecal calprotectin, that parallel the disease activity and correlate with mucosal healing, the notion of performing colonoscopy at fixed intervals sounds unjustifiable. The authors express their view that a response-guided colonoscopy (driven by normalization of clinical symptoms and inflammatory biomarkers), rather than a time-bound colonoscopy, would be more logical, apart from being cost-effective and patient-friendly.

Keyword

Colitis, ulcerative; Colonoscopy; Fecal calprotectin

Figure

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  Fig. 1. Proposed approach to monitoring of a patient after initiation of therapy. aSymptoms include increased frequency of stools, rectal bleeding and urgency; bAssessment of symptoms to be done between 4 and 24 weeks depending on the expected time to therapeutic response of the drug being used.

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