Response: Comments on “Adequacy of sigmoidoscopy as compared to colonoscopy for assessment of disease activity in patients of ulcerative colitis: a prospective study”
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We thank Dr Harindranath for his invaluable comments on our study [1]. The author has stated the fact that sigmoidoscopy is adequate for follow-up cannot be extrapolated from the results of the current study. However, as sigmoidoscopy was compared with colonoscopy on follow-up evaluation during the disease course of ulcerative colitis, the conclusion of adequacy of sigmoidoscopy has been reasonably reached given strong agreement [2].
The author has stated that the study lacks stratification based on disease extent like the study by Park et al. [3], however, the inclusion criteria of our research itself included patients with disease extent beyond the sigmoid colon at index colonoscopy. It has been stated in the study by Patel et al. that a limitation of the previous study by Park et al. is its inclusion of number of patients with proctitis being as high as 41.2% and left-sided colitis (29.6%). This created a bias by assessing patients with a disease limited to the rectosigmoid. The author has gone on to state the therapeutic implications of extensive colitis in comparison to left-sided colitis which is distinct from the basis of the current study, which states that in patients with disease extent beyond the sigmoid colon, a follow-up sigmoidoscopy is adequate to assess the variable disease severity.
The author has stated that most patients included in the study had mild disease as evidenced by low Mayo endoscopic sub-scores, that they are more likely to require colonoscopy and that it differs from real-world data. However, most of our patients had moderate disease (as per the median Mayo endoscopic subscore [MES] of 2). Active disease (MES>0) was present in 96 patients (96%) and disease was in remission (MES=0) in 4 patients (4%). Considering active disease as MES >1, active disease was present in 72 patients (72%) and disease was in remission in 28 patients (28%). The higher number of patients with active disease during follow-up of ulcerative colitis patients in our study represents the real-world data from our part of the world.
Notes
Funding Source
The author received no financial support for the research, authorship, and/or publication of this article.
Conflict of Interest
No potential conflict of interest relevant to this article was reported.
Data Availability Statement
Data will be made available upon reasonable request to corresponding author.
Author Contributions
Writing - original draft: Patel ST. Writing - review & editing: Chandnani S, Rathi PM. Approval of final manuscript: all authors.