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Ulcerative colitis can be endoscopically assessed and characterized as 'active' or 'inactive'. I was wondering how those disease states are related. Do patients with UC regularly alternate between active and inactive states? Or are there periods of activity flaring up, etc?

Context: Researcher looking at a dataset: GSE59071 from Vanhove et al. 2015. They have both of those states, but they don't mention the process behind the original diagnosis/significance of disease activity.

(Paper: Wiebe Vanhove et al.: "Strong Upregulation of AIM2 and IFI16 Inflammasomes in the Mucosa of Patients with Active Inflammatory Bowel Disease" Inflammatory Bowel Diseases, Volume 21, Issue 11, 1 November 2015, Pages 2673–2682, https://doi.org/10.1097/MIB.0000000000000535
Pubmed ID 26313692 or here)

  • (+1) Great question. Do you have a link to the research? That would make it easier for others to grasp your question and background. – Narusan Oct 24 '17 at 20:53
  • Sure! Those with an institution-affiliated access to the journal Inflammatory Bowel Diseases can find it through it's pubmed id: 26313692. For others, I uploaded it to tinyupload: s000.tinyupload.com/index.php?file_id=62717937294032214010 – CalendarJ Oct 24 '17 at 21:06
  • Diseases aren't a static entity. They fluctuate depending on various factors including response to treatment and immunity. – Graham Chiu Oct 26 '17 at 6:28
  • Thanks so much for the response! So the inactive vs active state could vary week to week? If so, then I won't give it a lot of weight in my analysis. But if it's a more steady thing, like a remission in cancer, perhaps that's more important. – CalendarJ Oct 26 '17 at 11:25
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    The states shouldn't fluctuate wildly, but they do vary based on a multitude of factors. Often someone will be completely asymptomatic but colonoscopy shows active disease. – Graham Chiu Oct 27 '17 at 5:19
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N.b. My institution does not have access to this journal and the upload you made has since been deleted

There are a number of ways of scoring the severity of ulcerative colitis on endoscopy; there are at least 8 in clinical use. They all take into account visible features such as vascular patterning, presence of ulcerations, the friability of the mucosal tissue and the presence of mucopurelent exudate.

A nice review of available activity scores in UC is available here:
Elizabeth R. Paine"Colonoscopic evaluation in ulcerative colitis", Gastroenterology Report, Volume 2, Issue 3, 1 August 2014, Pages 161–168, https://doi.org/10.1093/gastro/gou028

Unfortunately, without access to the methods section of this paper it isn't possible for me to say which score and at what threshold they defined "active" and "inactive".

The aim of UC treatment is to induce a remission state, usually through the use of high-dose steroids, then maintain this state with other drugs such as mesalazine. However, the hallmark of UC is "flaring" of the disease where symptoms worsen markedly.

I couldn't find much on the frequency of flares but his paper suggests that ~50% patients self-report a flare once a month or more frequently:
Susan C. Bolge et al.: "Self-reported frequency and severity of disease flares, disease perception, and flare treatments in patients with ulcerative colitis: Results of a national internet-based survey", Clinical Therapeutics, Volume 32, Issue 2, 238-245 https://doi.org/10.1016/j.clinthera.2010.02.010

As others have pointed out, the relationship between disease activity on an endoscopic level and symptom burden for the patient do not necessarily correlate well.

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