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Background An important therapeutic aim in ulcerative colitis (UC) is endoscopic remission. Although an endoscopic score with white light imaging (WLI) is mainly used to evaluate endoscopic findings, recently, the usefulness of linked color imaging (LCI) has been reported. We evaluated the relationship between LCI and histopathological findings and attempted to establish a new LCI endoscopic evaluation index for UC. Methods This study was conducted at Kyorin University, Kyoto Prefectural University, and Fukuoka University Chikushi Hospital. Ninety-two patients (median age, 46 years; male/female ratio, 48/34) with a Mayo endoscopic subscore (MES) ≤1 who underwent colonoscopy for UC in clinical remission between November 2016 and January 2019 were included. LCI index was defined as degree of redness (R) (grade 0–2), area of inflammation (A) (grade 0–3), and visibility of lymphoid follicles (L) (grade 0–3). Endoscopic scores were determined by three central endoscopic judgment committee members who are experts in colonoscopy for UC. Discussions were held among the three members, and when two or more of them had the same judgment this was adopted as the final evaluation. Each biopsy was performed from an identical site of colonoscopic image. Histological healing was defined as Geboes score <2B.1. Histopathological scores were also determined by central judgment. Results In 92 patients, 85 biopsies from the sigmoid colon and 84 biopsies from the rectum (total 169 biopsies) were evaluated. Percentage of judgments that were consistent in two or more central endoscopic judgment committee members were 167/169 (98.8%) cases in MES, 164/169 (97.0%) cases in LCI index-R, 152/169 (89.9%) cases in LCI-index-A, and 150/169 (88.8%) cases in LCI-index-L. Regarding the κ-score in diagnosing by the two pathologists, "Chronic inflammatory infiltrate", "Crypt destruction", and "Crypt destruction" had a moderate agreement, and others had a stationary agreement. The overall histological healing rate was 84.0% (142/169). There were 22/117/30 cases of grade 0/1/2 in LCI index-R, 113/34/17/5 cases of grade 0/1/2/3 in LCI index-A, and 124/27/14/4 cases of grade 0/1/2/3 in LCI index-L. Histological healing was achieved in 84.1% (142/169) of the cases, and there were significant associations with histological healing/non-healing in LCI index-R (P=0.013) and A (P=0.0014). Conclusion A new LCI index is useful for predicting histological healing in UC patients with MES ≤1 and clinical remission.

Background Chronic enteropathy associated with the SLCO2A1 gene (CEAS) is a hereditary disease caused by mutations of the SLCO2A1 gene which encodes a prostaglandin transporter. This disease is rare and intractable characterized by persistent blood and protein loss. There are few reports from Europe, and most reports are from Asian countries such as South Korea, China, and Japan. Because CEAS and Crohn's disease (CD) present ileal ulcers and stenoses, it is often difficult to distinguish CEAS from CD. Evaluation of characteristic upper gastrointestinal lesions observed in CEAS and extraintestinal findings, such as digital clubbing, periostosis, and pachydermia, can trigger suspicion of this disease, and genetic testing can be performed to confirm the diagnosis. Since little is known about the clinical features of CEAS, we conducted a nationwide survey in Japan. Methods All study participants provided written informed consent for genetic analysis. The present study was approved by the ethics committee of each institution. During the period between 2012 and 2022, 188 patients suspected of CEAS were enrolled in this study and checked to have SLCO2A1 gene mutations. We reviewed the clinical information of genetically confirmed CEAS patients. Results We confirmed the genetic analysis of 69 CEAS patients (24 males and 45 females) and found 19 different types of SLCO2A1 mutations. The median age at disease onset and diagnosis was 19 (range 1-69) and 42 (range 7-70) years, respectively. Parental consanguinity was present in 19 patients (26%). Although anaemia was present in almost all patients, only two patients experienced gross haematochezia. The median haemoglobin and serum total protein levels at diagnosis were 9.7 (range 2.3-14.4) and 5.3 (2.7-8.2) g/dl, respectively. Thirty-seven patients (54%) had undergone intestinal surgery. The most frequently involved gastrointestinal site was the ileum (94%), but the terminal ileum was rarely involved (4%). The lesions were shallow ulcers, varying in shape from circular, oblique, to longitudinal, sometimes forming pseudodiverticulum or luminal stenosis. The Gastric lesions were observed in 15 patients (22%) and duodenal lesions in 30 patients (43%). 20 patients (30%) had either mild digital clubbing, periostosis, or pachydermia. The extraintestinal findings, were more frequently found in males than in females (digital clubbing 52% vs 9%; periostosis 50% vs 10%; pachydermia 57% vs 0%). Conclusion Examination of the clinical features of CEAS reveals that ileal lesions are uniform and characteristic, but clinical features are diverse. Thirty per cent of patients with CEAS have extraintestinal features. There is a significant gender difference in extraintestinal features in CEAS patients.

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