Upfront tofacitinib in patients with biological-naïve ulcerative colitis - An Indian multicentric experience.

Background/AimsFour high-quality randomized controlled trials have proven the efficacy of fecal microbiota transplantation (FMT) in active ulcerative colitis (UC). We assessed the efficacy of FMT in a real-world setting involving steroid-dependent patients with UC.MethodsThis was a single-center prospective analysis of data from steroid-dependent patients with UC treated with FMT from September 2015 to September 2017 at the Dayanand Medical College, a tertiary care center in India. Fecal samples from random unrelated donors were administered through colonoscopy at weeks 0, 2, 6, 10, 14, 18, and 22. The primary outcome was achievement of steroid-free clinical remission, and the secondary outcomes were clinical response and endoscopic remission at 24 weeks. Modified intention-to-treat analysis was performed, which included subjects who underwent at least 1 FMT.ResultsOf 345 patients with UC treated during the study period, 49 (14.2%) had steroid-dependent UC. Of these 49 patients, 41 underwent FMT: 33 completed 7 sessions over 22 weeks according to the protocol, and 8 discontinued treatment (non-response, 5; lost to follow-up, 2; and fear of adverse effects, 1). At week 24, steroid-free clinical remission was achieved in 19 out of 41 (46.3%) patients, whereas clinical response and endoscopic remission were achieved in 31 out of 41 (75.6%) and 26 out of 41 (63.4%) patients, respectively. All patients with clinical response were able to withdraw steroids. There were no serious adverse events necessitating discontinuation.ConclusionsA multisession FMT via the colonoscopic route is a promising therapeutic option for patients with steroid-dependent UC, as it can induce clinical remission and aid in steroid withdrawal.

Background There are few data comparing the efficacy and safety of each Janus kinase (JAK) inhibitors in ulcerative colitis (UC) patients. We aimed to compare the real-world effectiveness and safety of tofacitinib (TOF) and filgotinib (FIL) which are JAK inhibitors applied for induction therapy in patients with UC. Methods We investigated the medical records of all UC patients who received TOF or FIL treatment as induction therapy between May 2018 and October 2023. We next selected the moderate to severe UC patients who matched the following criteria: partial Mayo Score (PMS) ≥3 or PMS =2 and a rectal bleeding subscore ≥1. A clinical response was defined as a reduction in PMS of ≥2 from baseline, with a rectal bleeding subscore ≤1 or a decrease of ≥1 from baseline. A clinical remission was defined as PMS ≤2, each subscore ≤1 and a rectal bleeding subscore of 0. The primary outcome was the clinical response at week 8 after therapy induction. The secondary outcomes were clinical response and remission at weeks 8 in patients without clinical response at week 4 after TOF or FIL administration and the safety during observation period. Results We identified 230 patients with moderate to severe UC who received either TOF (n = 197) or FIL (n = 33). Using propensity score-matching (PSM), thirty-three patients in both the TOF and FIL groups were isolated. PSM analysis showed that the rates of clinical response gradually increased to 72.2% at 8 weeks in the TOF group, whereas it tended to decrease to 48.5% in the FIL group. The clinical remission rates increased from 2 (36.7% in both groups) to 8 weeks (63.6% in the TOF group vs 48.5% in the FIL group). The rates of clinical response were higher in the TOF group than in the FIL group at week 8 in patients who did not achieve a clinical response at week 4 (38.5% vs. 0%; P = 0.011). The rates of clinical remission were also higher in the TOF group than in the FIL group at week 8 in patients who did not achieve clinical remission at week 4 (50.0% vs. 16.7%; P = 0.046). At least 1 adverse event occurred in 106 of 197 (53.8%) of patients in the TOF group and 11 of 33 (33.3%) in the FIL group. Conclusion TOF, unlike FIL, has the potential to benefit from continued treatment even if the patients did not show a significant clinical response/remission at 4 weeks after induction.

Background Resolvins originate from ω-3 PUFA (polyunsaturated fatty acid) precursors and play a role in the resolution of inflammation. The aim of this study was to determine the serum Resolvin E1 levels in patients with ulcerative colitis (UC) and to evaluate the relationship between the serum Resolvin E1 levels and ulcerative colitis disease activity. Methods In this observational study, serum samples were collected from 51 patients with UC and 30 healthy controls for the determination of Resolvin E1 levels. Firstly, we compared the serum Resolvin E1 levels between the UC patients and the control group. Subsequently, Resolvin E1 levels were analyzed in patients with active UC and UC in remission. Finally, the correlation between Resolvin E1 and C-reactive protein (CRP) and partial Mayo score (p-MS) was analyzed to determine the efficacy of Resolvin E1 in predicting disease activity. Results Serum Resolvin E1 level was determined in the UC group (3126 ± 1413 ng/ml) and in the control group (2758 ± 1065 ng/ml) (p = 0.187). Serum Resolvin E1 levels were determined in patients with active UC (3114 ± 1166 ng/ml) and patients in remission (3132 ± 1520 ng/ml) (p = 0.749). In the UC group, a low-grade positive significant association was found between Resolvin E1 and CRP (r = 0.303, p = 0.031). There was no significant association between Resolvin E1 and partial Mayo score (r = −0.207, p = 0.146). Conclusions There was no sufficient evidence that Resolvin E1 was an appropriate inflammatory marker to determine disease activity in UC.

Objectives: Eosinophilia is a prevalent laboratory abnormality that we encounter in day-to-day practice both in outpatient and inpatient settings. The causes range from primary to secondary spanning from an allergic response to clonal neoplastic proliferations. Identifying an etiology may be challenging in many cases and may sometimes require extensive evaluation. We aimed to find the clinical and etiological profile of patients with eosinophilia and the association of eosinophilia with end-organ involvement and IgE levels. Material and Methods: The study was designed as a cross-sectional study over a period of two years (2019 to 2020). The study setting was outpatient and inpatient medical wards of a tertiary care center in north India. A detailed history and clinical examination were done on patients with eosinophilia detected in blood counts. Standard diagnostic protocols guided by positive clinical and diagnostic tests were followed to find etiologies in patients with eosinophilia. Results: In our study, the most common cause overall and in each category of eosinophilia was parasitic infections (35%) followed by allergic disorders (29.3%). The most frequent symptoms were cough (32%), generalized weakness (25.5%), dyspnoea (24%), and a history suggestive of atopy (21%). On clinical examination, the most common finding was rhonchi or wheeze (24.5%). The most commonly affected end-organ was the lungs (13.2%) followed by the skin (4.7%). Conclusion: Parasitic infections are the most common cause of eosinophilia in our population. IgE levels correlate with a diagnosis of atopy or asthma and do not show a correlation with AEC. The lungs were the most frequently involved as end-organ in eosinophilia followed by the skin. We found no significant association between end-organ involvement and the degree of eosinophilia which highlights the importance of working up symptomatic patients for end-organ damage irrespective of the eosinophil count.

Background: The number of ulcerative colitis (UC) patients is increasing in Japan and other countries. Selective depletion of myeloid lineage leucocytes by adsorptive granulocyte and monocyte apheresis (GMA) with an Adacolumn (JIMRO, Takasaki, Japan) was introduced as a nonpharmacologic treatment strategy in UC patients in 2000. GMA has been reported to be effective in clinical trials; however, the effect of concomitant prednisolone (PSL) on GMA needs to be clarified. Methods: Thirty-nine patients with active UC were treated with GMA at our institute between June 2009 and September 2018. All patients received GMA therapy once or twice a week with the Adacolumn. Conventional medication was to be continued during the whole GMA treatment course. The clinical response was retrospectively evaluated. Results: According to the partial Mayo score, remission was 33.3%, significant efficacy 25.6%, effective 25.6%, and no response 15.4%. The average partial Mayo score was 6.2 ± 1.4 at entry and significantly declined to 1.8 ± 1.8 after GMA sessions (p < 0.0001). The average number of bowel movements was 9.5 ± 5.6 at entry and significantly declined to 3.0 ± 2.8 after GMA sessions (p < 0.0001). In a comparison between the group treated with concomitant PSL and the group without PSL, the change in partial Mayo score or the number of bowel movements from entry to after GMA sessions was not significantly different. Among 24 patients treated by GMA with concomitant PSL, 75% (18/24) became steroid free. Conclusions: The effect of GMA with concomitant PSL and that of GMA without PSL were not different, and GMA was effective irrespective of PSL administration. The present study showed that GMA had efficacy and led many UC patients treated by PSL to be steroid free with no safety concern in the real world, although there is the possibility of recruitment bias due to the retrospective nature of the study.

Introduction: Atopic dermatitis (AD) is a chronic, inflammatory, relapsing skin disorder with early age of onset in infancy and early childhood. A gradual increase in the prevalence of AD has been observed recently, especially in low-income countries like ours. Objective: We aimed to study the epidemiology and clinical profile of AD among pediatric age group in a tertiary care hospital in North India. Materials and Methods: A hospital-based cross-sectional study was conducted over 1 year in the department of dermatology and sexually transmitted diseases in a tertiary care center in India. All children diagnosed with AD, aged 0–18 years, were recruited, and their clinical and demographic data were recorded. Results: In the 62 children having AD, the mean age was 7.7 ± 6.3 years. Majority of children belonged to the age group of 1–5 years. The mean age of onset of AD was 2.3 ± 2.2 years. A personal history of atopy was present in 53.2% of children, whereas 48.3% of children had a family history of atopy. Acute AD was the most common clinical type that was noted in 43.5%. Hyperlinearity of palms, keratosis pilaris, pityriasis alba, and periorbital darkening were found in 59.6%, 33.8%, 24.1%, and 29% of children, respectively. Conclusion: The prevalence of AD is low in developing countries like India, but it is slowly rising due to rapidly evolving urbanization and environmental changes. Disease manifestation is usually mild to moderate in Indian patients; hence, vigilant eyes and high clinical suspicion are required for accurate diagnosis and efficient management of AD in Indian settings.

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Background Subcutaneous infliximab (IFX-SC) has shown comparable efficacy and safety with IV infliximab in ulcerative colitis (UC) or Crohn's disease (CD) since its launching in 2021. We aimed to investigate the one-year real-life efficacy and durability of IFX-SC in Korea. Methods From September 2021 to November 2023, patients with moderate-to-severe UC or CD, who are naive to any types of biologic agents or IFX were prospectively enrolled from 41 tertiary referral centers in Korea. After IV infliximab induction from Week (W) 0 to W2, patients received IFX-SC every 2 weeks from W6. Patients who administered IFX-SC less than W14 were excluded. Clinical remission (CREM), clinical response (CRES) at W26, W50, and one-year drug survival were assessed. In patients with CD, CREM was defined as Crohn’s disease activity index (CDAI) &amp;lt;150 points, and CRES was defined as a reduction in CDAI ≥70 points from baseline. In patients with UC, CREM was defined as partial Mayo score(pMS) of ≤1 points with no individual subscore of &amp;gt;1 point, and CRES was defined as a reduction from baseline in pMS of ≥2 points and ≥30% along with either a reduction in rectal bleeding subscore (RBS) of ≥1 point or an absolute RBS of ≤1 point19. Drug survival was evaluated based on the time of drug persistence from W0 to the last date of IFX-SC administration among drug-off cases. Results A total of 192 patients (UC with 53, and CD with 139) were enrolled, consisting of about 80% of biologic naïve cohort. Enrolled patients included young adults with a male predominance (Table 1). At W26, patients with UC showed 54.5% CREM and 88.6% CRES (Figure 1A). Among patients with CD, rates of CREM and CRES were 92.1% and 97.0%, respectively. Similarly, W50 CREM and CRES were also favorable with a rate of 57.1% and 89.3% among UC patients. In addition, among CD patients, favorable outcome was more obvious, showing 84.6% and 93.8% of CREM and CRES. Meanwhile, one-year drug survival was also investigated. As shown on the Figure 1B, one-year drug survival probability seemed favorable with a survival rate over 97% in both UC and CD patients (UC; 98.1% at W26 with 95% confidence interval [CI], 0.874–0.852, 96.1% at W50, 95% CI, 0.852–0.990, and CD; 97.8% at W26 with 95% CI, 0.933–0.993, 97.8% at W50 with 95% CI, 0.933–0.993). During the study, 3.1% (six patients) of serious adverse events were reported. Conclusion IFX-SC seems to be efficacious therapeutic option for patients with moderate-to-severe UC or CD patients in real-world settings. With a favorable drug survival and tolerable safety profile, it may facilitate individualized treatment with a good compliance.

Background Serum leucine-rich alpha-2 glycoprotein (LRG) is a biomarker reflecting endoscopic activity in patients with ulcerative colitis (UC) and, may serve as treatment target for advanced therapy (AT), like C-reactive protein (CRP). However, unlike CRP, serum LRG is produced also by intestinal epithelium in response to stimulation not only by Interluekin-6 (IL-6) but also tumor necrosis factor (TNF) and IL-22. Therefore, a certain number of cases exist where serum LRG is elevated even when CRP is negative. This study aimed to investigate the optimal selection of AT based on serum LRG levels in patients with UC with serum CRP-negative. Methods This was a multicentre prospective cohort study including 259 patients with UC who received AT from January 2019 to March 2024 at 16 hospitals. Among them, 134 patients with UC with CRP-negative who received one of four classes of AT—anti-TNF, vedolizumab (VDZ), ustekinumab (UST), or Janus kinase inhibitor (JAKi)—were included in the present analysis [anti-TNF, n = 27; VDZ, n = 41; UST, n = 42; JAKi, n = 24]. The effectiveness and safety of AT was assessed by comparing the proportion of clinical remission (CR) at week 52 and the incidence rate of adverse events (AE) requiring discontinuation of AT using the person-year (PY) method. We defined CR as a partial Mayo score ≤2, with each subscore ≤1 and no-bleeding, CRP-negative as &amp;lt; 0.20 mg/dL and the low-LRG group as &amp;lt; 14.0 μg/mL, the high-LRG group as ≥ 14.0 μg/mL. Results Among 134 patients with UC who had negative CRP (female, 43%; pancolitis, 73%; AT exposure, 38%), 59 patients (44%) were classified as the high-LRG group. At week 0, median serum LRG and CRP levels were 13.1 μg/mL [Interquartile range (IQR) 10.7-17.9] and 0.04 mg/dL [IQR 0.00-0.09]. Concomitant corticosteroids and immunomodulators were used in 65 (49%) and 47 (35%) patients. In high-LRG group, the proportion of patients achieved CR at week 52 tended to differ among the four AT classes and that in patients received VDZ was only &amp;lt;50% (P = 0.091; anti-TNF, 88%; VDZ, 42%; UST, 60%; JAKi, 75%), and there was no difference in the incidence rate of AEs (anti-TNF, 0; VDZ 0.9; UST, 3.0; JAKi, 0 per 100PY). In low-LRG group, the proportion of CR at week 52 was significantly different among the four AT classes and that in patients received VDZ or UST was &amp;gt;70% (P = 0.013; anti-TNF, 39%; VDZ, 75%; UST, 73%; JAKi, 33%), and there was no difference in the incidence rate of AEs (anti-TNF, 0; VDZ 0.9; UST, 3.0; JAKi, 0 per 100PY) Conclusion For AT selection in CRP-negative UC patients, ATs other than VDZ can be prioritized in the high-LRG group, whereas VDZ and UST are appropriate in the low-LRG group. Conflict of interest: Dr. Amano, Takahiro: No conflict of interest Yoshihara, Takeo: No conflict of interest Sakakibara, Yuko: No conflict of interest Yamada, Takuya: No conflict of interest Hiyama, Satoshi: No conflict of interest Murayama, Yoko: No conflict of interest Ogiyama, Hideharu: No conflict of interest Uema, Ryotaro: No conflict of interest Tsujii, Yoshiki: No conflict of interest Inoue, Takahiro: No conflict of interest Shinzaki, Shinichiro: Shinichiro Shinzaki has received grant support from AbbVie, EA Pharma, Nippon Kayaku, advisor fees from AbbVie, EA Pharma, Gilead Sciences, Janssen Pharmaceutical, Sekisui Medical and Takeda Pharmaceutical and honoraria from AbbVie, EA Pharma, Gilead Sciences, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Nippon Kayaku, Pfizer, Sekisui Medical, and Takeda Pharmaceutical. Iijima, Hideki: No conflict of interest Hayashi, Yoshito: No conflict of interest

Background Our aim was to evaluate the effectiveness and safety of tofacitinib in ulcerative colitis (UC) in real life. Methods Patients from the prospectively maintained ENEIDA registry treated with tofacitinib due to active UC were included. Clinical activity and effectiveness were defined based on Partial Mayo Score (PMS). The short-term response was assessed at week 4, 8 and 16. The last-observation-carried-forward method was used in patients that stopped tofacitinib before the time-points for clinical assessment. Variables associated with short-term remission at week 8 were identified by logistic regression analysis. The cumulative retention rate and the cumulative incidence of relapse over time were assessed by survival curves. Cox-regression analysis was performed to identify predictive factors of tofacitinib discontinuation or relapse over time. Data quality was assessed by remote monitoring. Results 113 patients were included (Table 1 and Figure 1) and exposed to tofacitinib a median of 44 (interquartile range = 30–66) weeks. Response and remission at week 8 were 60% and 31%, respectively (Figure 2). In multivariate analysis, higher PMS at week 4 [odds ratio (OR)=0.2; 95% confidence interval (CI) = 0.1–0.4] was the only variable associated with the likeliness of achieving remission at week 8. Higher PMS at week 4 (OR = 0.5; 95% CI = 0.3–0.7) and higher PMS at week 8 (OR = 0.2; 95% CI = 0.1–0.5) were associated with lower probability of achieving remission at week 16. Twenty per cent of those without remission at week 4, and 12% of those without remission at week 8, achieved remission at week 16. A total of 45 patients (40%) discontinued tofacitinib over time (Figure 3); the discontinuation rate was 34% and 46% at 24 and 52 weeks, respectively. PMS at week 8 was the only factor associated with tofacitinib discontinuation [Hazard ratio (HR) = 1.5; 95% CI = 1.3–1.6)]. A total of 33 patients had remission at week 8; from them, 65% relapsed 52 weeks after achieving remission; 9 patients increased the dose to 10 mg /12 h and 5 reached remission again. No factors associated with relapse over time were identified. Eighteen patients had adverse events (4 hypercholesterolaemia, 2 herpes zoster, 3 infections, 2 dyspnoea, 1 neoplasia, 1 lymphopenia, 1 headache, 1 hypertriglyceridaemia and 4 others). No thromboembolic events were reported. Conclusion Tofacitinib is relatively effective in UC patients in real practice even in a highly refractory cohort. Only 10% of the patients without remission at week 8 reached remission at week 16. A relevant proportion of patients discontinue the drug over time, mainly due to primary failure. Over 60% of patients that achieve remission, relapse over time. Safety was consistent with the known profile of tofacitinib

In India, where cancer incidence is rising, and healthcare infrastructure in tertiary care centers is strained, the outcomes of cancer patients requiring intensive care unit (ICU) care remain poorly understood. We aim to describe demographic, clinical, and survival data and to identify factors associated with mortality in non-elective medical admissions of critically ill cancer patients to ICU in a tertiary care hospital. Retrospective observational study of non-elective medical admissions of critically ill adult cancer patients to the ICU with a diagnosis of solid organ or hematological malignancies between 1st January 2018 and 31st December 2022. Data regarding patient and neoplasm characteristics, ICU admission features, and outcomes were collected from medical records and ICU charts. A total of 204 non-elective medical admissions of critically ill cancer patients to the ICU were analyzed. Hematological malignancies were documented in 53.9% patients. The main causes of admission to the ICU were febrile neutropenia (34.3%), respiratory failure (31.8%), sepsis (9.8%), and shock (7.8%). The mean length of ICU stay was 5.62 ± 5.67 days. Intensive care unit mortality was 52.94%. The most common cause of mortality was septic shock (53.7%). The need for invasive mechanical ventilation (IMV) [adjusted odds ratio (OR) 0.113; 95% confidence interval (CI) 15.98 (4.22-60.56), p < 0.001], use of vasopressors (adjusted OR 12.59; 95% CI: 3.45-45.94, p < 0.001), need for dialysis (adjusted OR 17.99; 95% CI: 1.97-164.45, p = 0.01), and tracheostomy (adjusted OR 0.15; 95% CI: 0.03-0.7, p = 0.016), were independent risk factors associated with higher ICU mortality. An increasing number of cancer patients require intensive care, and our study suggests that many of these patients have a reasonable chance of surviving their ICU stay. The in-ICU mortality of 52.94% was observed at our tertiary care center in India. Independent predictors of mortality included age, type of malignancy, treatment intent, need for early IMV, vasopressors, and dialysis in the ICU. Sandill S, Mishra S, Garg R, Gupta N, Bharti SJ, Kumar V, et al. Outcomes of Cancer Patients Requiring Non-elective Medical Admission to the Intensive Care Unit of a Tertiary Care Center in India: A 5-year Retrospective Study. Indian J Crit Care Med 2026;30(1):13-18.

Janus kinase (JAK) inhibitors are an important treatment option for ulcerative colitis, providing rapid onset of action, oral administration, and efficacy even after biologic failure. The 3 approved agents—tofacitinib, filgotinib, and upadacitinib—differ in JAK isoform selectivity, leading to clinically meaningful differences in efficacy and safety. Evidence from network meta-analyses, clinical trials, and real-world studies consistently shows that upadacitinib provides the highest efficacy for induction and maintenance of remission, whereas filgotinib demonstrates the most favorable safety profile. The strong efficacy of upadacitinib and tofacitinib is particularly relevant in patients with severe disease, including acute severe ulcerative colitis, and upadacitinib maintains high efficacy regardless of prior advanced therapy exposure. JAK inhibitors also benefit extraintestinal manifestations. Although risks such as herpes zoster, serious infection, thromboembolism, and major cardiovascular events differ among agents, long-term data suggest generally acceptable safety when used appropriately. Intraclass JAK-to-JAK cycling is feasible, with about half of patients achieving steroid-free clinical remission in retrospective cohorts. Based on mechanistic, clinical, and real-world evidence, filgotinib may be a first-line option for patients with lower disease activity or when safety is a priority, whereas upadacitinib or tofacitinib may be preferred in higher disease activity. Strategically selecting agents may improve durability and outcomes.

Su1280 The Modified Mayo Endoscopic Score (MMES): A New Score for the Assessment of Extension and Severity of Endoscopic Activity in Ulcerative Colitis (UC) Patients

Background Vedolizumab is a monoclonal antibody against integrin α4β7 that is being used for the treatment of moderate to severe Ulcerative Colitis (UC) and Crohn’s Disease (CD). Recent studies have shown conflicting results for the effect of concomitant azathioprine use with vedolizumab monotherapy. In this single center cohort study, we investigated the effect of concomitant azathioprine treatment on vedolizumab drug persistence in UC and CD treatment. Methods We performed a retrospective review of all adult (≥18 years) UC and CD patients started on VDZ at our infusion center. Data collection included baseline demographics, concomitant azathioprine therapy, VDZ therapy and disease activity scores using the partial Mayo score and Harvey Bradshaw Score. Data were obtained from the digital medical record. The primary outcome measure was VDZ persistence, represented in Kaplan-Meier analysis. This analysis assessed persistence on every 8 week dose regimen. Results This single center cohort included 142 VDZ treated UC (n=64) and CD (n=78) patients. All patients had a history of at least one anti-TNF treatment: Mean age 38.9±12.5 years and male gender 84 (59.2%). Median disease duration was 6±1.6 years. 6 Patients were excluded from the analysis since VDZ therapy has been stopped due to side effects. Mean duration of VDZ treatment in Crohn’s disease was 96.5±69.2 weeks and in UC was 72.1±60.5 weeks. Concomitant azathioprine therapy in CD increased VDZ persistence rate. However, in UC concomitant azathioprine therapy did not effect VDZ persistence rate. Conclusion The real-world data collected in this study demonstrate that concomitant azathioprine treatment increase the VDZ persistence rate in Crohn’s disease. However, concomitant azathioprine treatment does not effect the VDZ persistence rate in UC patients.

In active ulcerative colitis, colonic nitric oxide (NO) generation is enhanced and probably has an important role in its pathogenesis. We tested the reliability of an NO electrode in monitoring colonic NO levels in ulcerative colitis patients and control subjects and its possible usage as a marker of disease activity. Colonic NO level was determined by the NO detection system model NO-501 (InterMedical, Nagoya, Japan). The working electrode was inserted into a 7-mm diameter polyvinyl tube and introduced at a distance 6 cm from the anus. In each subject sigmoidoscopy was performed and mucosal biopsies were obtained. NO synthase (NOS) activity was determined by monitoring the conversion of 3H-arginine to citrulline. Colonic NO level is significantly increased in patients with active ulcerative or Crohn's colitis--more than 2-fold higher than in control subjects. There was good correlation between colonic NO level and NOS activity and the clinical and endoscopic indices of disease activity. Direct determination of colonic NO level is convenient, and reliable, and may help to monitor disease activity in ulcerative colitis.