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This study demonstrated that the frequency of Treg cells in PBMCs was decreased in patients with CU. Further studies are needed to clarify the exact role of Treg cells in the pathogenesis of CU and factors regulating their function.

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Background and aims: Assessment of mucosal visualization during esophagogastroduodenoscopy (EGD) can be improved with a standardized scoring system. To address this gap, we created the Toronto Upper Gastrointestinal Cleaning Score (TUGCS). Methods: We developed the TUGCS using Delphi methodology, whereby an international group of endoscopy experts iteratively rated their agreement with proposed TUGCS items and anchors on a 5-point Likert scale. After each Delphi round, we analyzed responses and refined the TUGCS using an 80% agreement threshold for consensus. We used the intra-class correlation coefficient (ICC) to assess inter-rater and test-retest reliability. We assessed internal consistency with Cronbach’s alpha and item-total and inter-item correlations with Pearson’s Correlation Coefficient. We compared TUGCS ratings with an independent endoscopist’s global rating of mucosal visualization using Spearman’s rho. Results: We achieved consensus with 14 Delphi participants after three Delphi rounds. Inter-rater reliability was high at 0.79 (95% CI [0.64-0.88]). Test-retest reliability was excellent at 0.83 (95% CI [0.77-0.87]). Cronbach’s α was 0.81, item-total correlations ranged from 0.52-0.69, and inter-item correlations ranged from 0.38-0.74. There was a positive correlation between TUGCS ratings and a global rating of visualization (r = 0.41, p=0.002). TUGCS ratings for EGDs with global ratings of excellent were significantly higher than EGDs with global ratings of fair (p=0.010). Conclusion: The TUGCS has strong evidence of validity in the clinical setting. The international group of assessors, broad variety of EGD indications, and minimal assessor training improves generalizability and potential for dissemination.