Intestinal Research

Original Articles

Clinical spectrum of acute severe ulcerative colitis in the biologic era: a prospective cohort study from India: Arshdeep Singh, Mayur Luthra, Arshia Bhardwaj, Ramit Mahajan, Riya Sharma, Dharmatma Singh, Devanshi Jain, Omesh Goyal, Varun Mehta, Kirandeep Kaur, Yogesh Kumar Gupta, Vandana Midha, Ajit Sood; Received November 18, 2024 Accepted March 4, 2025 Published online June 9, 2025; DOI: https://doi.org/10.5217/ir.2024.00189 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Acute severe ulcerative colitis (ASUC) is a time-critical situation requiring urgent intervention. Limited data exist on the evolving clinical spectrum of ASUC in the era of advanced therapies.
Methods
This prospective real-world observational cohort study included 145 adult patients hospitalized with ASUC between January 2020 and June 2024. ASUC was defined by the modified Truelove and Witts criteria. Demographics and disease characteristics, including disease severity, probable precipitating factors, and corticosteroid failure rates, were recorded.
Results
The median age of patients was 36 years (interquartile range, 26–48.5 years) with 63 females (43.4%). Most patients had left-sided colitis (53.1%). The median disease duration was 1 year (IQR, 0.5–3 years), with 91 patients (62.7%) presenting with ASUC within the first year of diagnosis of ulcerative colitis. One-third of the patients had previous exposure to biologics and small molecules. The most commonly reported probable precipitants of ASUC were poor compliance with treatment (n = 43, 29.6%), antibiotic use (n = 35, 24.1%), high perceived stress (n = 32, 22.1%), and Clostridioides difficile infection (n = 19, 13.1%). Forty patients (27.5%) were non-responders to intravenous corticosteroids (IVCS). Twenty-nine patients (20%) received medical rescue therapy (infliximab, n = 14 [48.27%], cyclosporine A, n = 6 [20.68%], and tofacitinib, n = 9 [31.03%]). Seven patients (4.82%; 4 after non-response to IVCS and 3 after non-response to medical rescue therapy) underwent colectomy.
Conclusions
In this cohort of ASUC patients, poor treatment compliance, antibiotic use, stress, and C. difficile infection were common precipitants of flare-ups. Nearly one-third of patients required medical rescue therapy, and a small proportion ultimately underwent colectomy.

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IBD

Predictive accuracy of fecal calprotectin for histologic remission in ulcerative colitis: Arshdeep Singh, Arshia Bhardwaj, Riya Sharma, Bhavjeet Kaur Kahlon, Ashvin Singh Dhaliwal, Dharmatma Singh, Simranjeet Kaur, Devanshi Jain, Namita Bansal, Ramit Mahajan, Kirandeep Kaur, Aminder Singh, Vikram Narang, Harpreet Kaur, Vandana Midha, Ajit Sood; Intest Res 2025;23(2):144-156. Published online November 11, 2024; DOI: https://doi.org/10.5217/ir.2024.00068

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Accurate assessment of disease activity is crucial for effective management and treatment of ulcerative colitis (UC). This study evaluated the correlation between clinical, endoscopic, and histologic measures of disease activity in UC.
Methods
Clinical, biochemical, endoscopic, and histologic disease activity was studied in 347 patients with UC. Agreements among various histologic classification systems, namely the Geboes Score (GS), Continuous GS, Nancy Index (NI), and Robarts Histopathology Index (RHI), were analyzed. The predictive accuracy of fecal calprotectin (FC) for endoscopic and histologic remission was assessed.
Results
We demonstrate a fair to moderate correlation between clinical, endoscopic, and histologic measures of disease activity in UC. There was a robust concordance among GS, Continuous GS, NI, and RHI in distinguishing between patients in histologic remission or activity. The NI detected 75% of patients who met the remission criteria according to the RHI, whereas the RHI identified all patients in remission as defined by the NI. FC levels below 150 μg/g had >70% accuracy in predicting endoscopic remission. FC levels below 150 μg/g showed ≥80% accuracy, and FC levels below 100 μg/g demonstrated ≥ 85% accuracy in predicting histologic remission, regardless of the scoring index applied. Elevated FC levels were associated with both acute and chronic inflammatory infiltrates in biopsy samples.
Conclusions
FC is a reliable predictor of histologic remission, with higher accuracy at lower thresholds. The GS, Continuous GS, NI, and RHI demonstrate comparable performance. FC could help stratify patients’ need for colonoscopy for the assessment of endoscopic and histologic remission.

Citations

Citations to this article as recorded by

KASID and Intestinal Research journal: a central academic hub for research of intestinal diseases in the Asia-Pacific region
Jae Hee Cheon, Hye Kyung Hyun, You Sun Kim, Dong Il Park, Tae Il Kim, Dong Soo Han
Intestinal Research.2026; 24(1): 6. CrossRef
Beyond mucosal healing: fecal calprotectin and the path toward histologic remission in ulcerative colitis
Yehyun Park
Intestinal Research.2025; 23(2): 115. CrossRef
Azathioprine or Tofacitinib as Maintenance Therapy in Corticosteroid‐Responsive Acute Severe Ulcerative Colitis
Arshdeep Singh, Arshia Bhardwaj, Riya Sharma, Dharmatma Singh, Devanshi Jain, Namita Bansal, Gursimran Singh Kochhar, Vandana Midha, Ajit Sood
Alimentary Pharmacology & Therapeutics.2025; 62(7): 722. CrossRef
Endo-histologic outcomes in patients with ulcerative colitis responding to tofacitinib
Arshdeep Singh, Arshia Bhardwaj, Devanshi Jain, Riya Sharma, Dharmatma Singh, Ramit Mahajan, Kirandeep Kaur, Aminder Singh, Vikram Narang, Harpreet Kaur, Manavjot Singh, Pritish Gupta, Tanisha Sehgal, Vandana Midha, Ajit Sood
Indian Journal of Gastroenterology.2025;[Epub] CrossRef
Crosstalk between neutrophil extracellular traps and gut microbiota in ulcerative colitis: traditional Chinese medicine strategies
Yiyi Feng, Yuchen Liu, Xiuxiu Qiu, Jianfang Jiang, Jianling Mo, Yichuan Xv
Frontiers in Cellular and Infection Microbiology.2025;[Epub] CrossRef
Non-Invasive vs. Invasive Markers in Ulcerative Colitis: A Systematic Review of Intestinal Ultrasound, Biopsy, and Faecal Calprotectin
Viviana Parra-Izquierdo, Juliette De Avila, Oscar Gómez, Nelson Barrero, Miguel Duarte, Consuelo Romero-Sánchez
International Journal of Molecular Sciences.2025; 26(17): 8129. CrossRef

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