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Predicting treatment response in ASUC: do we measure systemic severity, organ response or both?
  1. Pernille D Ovesen1,
  2. Johan Fredrik Kristoffer Fremberg Ilvemark1,
  3. Rune Wilkens2,3,
  4. Casper Steenholdt1,
  5. Jakob Seidelin1,4
  1. 1Department of Gastroenterology and Hepatology, Herlev Hospital, Herlev, Denmark
  2. 2Digestive Disease Center, Copenhagen University Hospital - Bispebjerrg, Copenhagen, Denmark
  3. 3Copenhagen Intestinal Ultrasound, Copenhagen, Denmark
  4. 4Department of Clinical Science, University of Copenhagen Faculty of Health and Medical Sciences, Kobenhavn, Denmark
  1. Correspondence to Professor Jakob Seidelin, Department of Gastroenterology and Hepatology, Herlev Hospital, Herlev 2730, Denmark; jakob.benedict.seidelin{at}regionh.dk

https://doi.org/10.1136/gutjnl-2023-331793

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    We would like to congratulate Adams et al on the paper addressing the important issue regarding the development of prognostic clinical indexes for patients with acute severe ulcerative colitis (ASUC) leading to the development of the ADMIT-ASC score.1

    Although we acknowledge the initiative, the development of a static prognostic index might be reconsidered with the increased availability and use of noninvasive and real-time cross-sectional imaging.

    Recently, we investigated the use of intestinal ultrasound (IUS) to measure early changes in the sigmoid bowel wall thickness (BWT) as an indicator of intravenous corticosteroid (CS) response in patients admitted with ASUC. A >20% reduction in BWT after 48 hours predicted CS response within 7 days (p<0.0001 for pMayo response, p=0.006 for no need of rescue therapy) and was superior to CRP, albumin or pMayo response at 48 hours in multivariate analysis.2

    With C-reactive protein (CRP), albumin and endoscopic severity scores being major components of the ADMIT-ASC score, we set out to apply this score to our cohort and indeed we did find a good correlation with CS-response across the different ADMIT-ASC scores between the Ilvemark …

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    Footnotes

    • Twitter @RuneWilkens, @jakobseidelin

    • Contributors PDO: study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; statistical analysis. JFKFI: acquisition of data, critical revision of the manuscript for important intellectual content; statistical analysis. RW: critical revision of the manuscript for important intellectual content. CS: critical revision of the manuscript for important intellectual content. JS: study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; statistical analysis; obtained funding; study supervision.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests JFKFI has received research grants from Takeda, Janssen, Abbvie, ParaTech, the Danish Research Council, and the Capital Region of Denmark. RW has received grants/personal fees from Janssen, Takeda, Pfizer, Abbvie and Alimentiv. CS has served as speaker and advisory board member for MSD and Janssen. JS has received research grants from Takeda, Janssen, the Danish Research Council and the Capital Region Denmark and is national coordinator of studies from AbbVie, Arena Pharmaceuticals, Ely Lilly and Boehringer Ingelheim.

    • Provenance and peer review Not commissioned; externally peer reviewed.