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Background & Aims: Mucosal healing, based on histologic analysis, is an end point of maintenance therapy for patients with ulcerative colitis (UC). There are few data on how histologic signs of inflammation correlate with endoscopic and peripheral blood measures of inflammation in these patients. We investigated patterns of histologic features of inflammation in patients with UC in clinical remission, and correlated these with endoscopic and biochemical measures of inflammation. Methods: We performed a prospective observational study of 103 patients with UC in clinical remission undergoing surveillance colonoscopy while receiving maintenance therapy with mesalamine or thiopurines; 2674 biopsy specimens were collected from 708 colonic segments. Each colonic segment was evaluated based on the Mayo endoscopic subscore and the Geboes histology score (range, 0−5.4). Biomarkers were measured in peripheral blood samples. Results: Histologic features of inflammation were found in 54% of patients receiving maintenance therapy; 37% had at least moderate inflammation based on histology scores. Of the 52 patients with endoscopic evidence only of left-sided colitis, 34% had histologic features of inflammation in their proximal colon. Histology scores correlated with endoscopic scores for per-segment inflammation (Spearman ρ = 0.65; P < .001). Patients with histology scores greater than 3.1 had a significantly higher mean level of C-reactive protein than those with scores less than 3.1. There were no differences among treatment groups in percentages of patients with histologic scores greater than 3.1. Conclusions: Patients in clinical remission from UC still frequently have histologic features of inflammation, which correlate with endoscopic appearance. Patients with at least moderate levels of inflammation, based on histologic grading (score >3.1), have higher serum levels of C-reactive protein, which could be used as a surrogate marker of histologic inflammation. [Copyright &y& Elsevier]

Abstract: Flat and sessile colonic lesions are being identified more frequently because of increased awareness, improved endoscopic skills, and enhanced imaging. Endoscopic mucosal resection (EMR) is now a well-developed technique in the treatment of large sessile lesions and advanced mucosal neoplasia of the colon. Significant cost, morbidity, and mortality benefits may be obtained from this minimally invasive technique. Careful lesion assessment is mandatory, and the patient''s general health and comorbidities should be factored into the therapeutic plan. Recent technical advances allow resection of larger and more complex lesions in excess of 50 mm and involving more than two-thirds of the circumference of the colonic wall as an outpatient. Meticulous resection technique is crucial to maximize procedural success. EMR is associated with a small, but significant, risk of bleeding and perforation. Endoscopists need to be aware of risk factors for these events and techniques of early detection. Early identification and endoscopic treatment ameliorates the frequency and severity of adverse events. This review will discuss the general principles of EMR, including lesion assessment, equipment selection, endoscopic technique, and early identification and treatment of complications. [Copyright &y& Elsevier]

Background & Aims: Limited data are available on the contribution of chronic HCV infection to the development of bone disease in postmenopausal women. We studied whether women who acquired HCV infection through administration of HCV genotype 1b–contaminated anti-D immunoglobulin from a single source had decreased bone mineral density (BMD) or altered levels of bone turnover markers (BTMs), compared with women who spontaneously resolved infection or age-matched healthy controls. Methods: From a cohort of postmenopausal Irish women, we compared BMD, determined by dual-energy x-ray absorptiometry, and a panel of BTMs in 20 women chronically infected with HCV (PCR+), 21 women who had spontaneously resolved infection (PCR−), and 23 age-matched healthy controls. Results: Levels of BTMs and BMD were similar in PCR+ and PCR− women and healthy age-matched controls. However, there was an increased frequency of fractures in PCR+ (n = 6) compared with PCR− women (n = 0, P = .007). PCR+ women with fractures were postmenopausal for a longer time (median, 15.5, range, 5–20 years vs 4.5, range, 1–20 years in PCR+ women without fractures; P = .033), had lower BMD at the hip (0.79, range, 0.77–0.9 g/cm2 vs 0.96, range, 0.81–1.10 g/cm2; P = .007), and had a lower body mass index (23.7, range 21.2–28.5 kg/m2 vs 25.6, range 22.1–36.6 kg/m2; P = .035). There was no difference in liver disease severity or BTMs in PCR+ women with or without fractures. Conclusions: Chronic HCV infection did not lead to discernable metabolic bone disease in postmenopausal women, but it might be a risk factor for bone fractures, so preventive measures should be introduced. To view this article''s video abstract, go to the AGA''s YouTube Channel. [Copyright &y& Elsevier]