K. Uchiyama*1, T. Takagi1, T. Nakano1, S. Kashiwagi1, N. Yagi2, Y. Naito1, Y. Itoh1
1Kyoto Prefectural University of Medicine, Molecular Gastroenterology and Hepatology, Kyoto, Japan, 2Asahi University Hospital, Department of Gastroenterology, Gifu, Japan
Recently, it has been reported that not only mucosal healing but also histological assessment of inflammation is important to predict prognosis of the patients of ulcerative colitis. However, it has not been established the endoscopic classification to reflect mucosal inflammation. In the present study, we investigated the possibility of linked colour imaging (LCI) to diagnose mucosal inflammation such as inflammatory cell infiltration and cytokine expression.
All examinations were carried out with an EG-L590WR endoscope and a LASEREO endoscopic system (FUJIFILM Co., Tokyo, Japan) including 78 UC patients with clinically remission (Under 4 of Lichtiger CAI score). Endoscopic images and biopsy samples were taken at caecum, sigmoid colon, rectum, and additional area with mucosal redness and diagnosed by endoscopic LCI classification (LCI-A, -B, -C)(Uchiyama K, et al., J Crohns Colitis 2017;11(8):963–969). Inflammation in the biopsy specimens were evaluated according to Geboes score and cytokine expression was evaluated by real-time PCR. The patients were observed for 30 months at longest.
Total number of images was 365, and biopsy samples were taken from all of these areas. Geboes score was significantly higher in LCI-C area compared with LCI-B, and LCI-A. Cytokine mRNA expression such as TNF-α, IL-6, IFN-γ, IL-1b, IL-8, and IL-23 were well correlated with LCI classification. But IL-12, IL-17, and IL-10 were not significantly correlated with LCI classification. No relapse was observed in the group with LCI-A (n = 8). The relapse rate of LCI-B, and -C was 35.7% (15/42) and 46.4% (13/28). Geboes score was higher at relapse group, but there was no difference of mucosal cytokine expression between relapse group and non-relapse group.
The LCI classification is considered as a practical approach to diagnose mucosal inflammation in UC patients. However, further study is necessary to reveal the relation between relapse of UC and mucosal cytokine profile.