Kana Shiraishi1, Shinya Furukawa2, Sen Yagi3, Kenichirou Mori4, Tomoyuki Ninomiya4, Keitarou Kawasaki5, Yuji Mizukami6, Seiyuu Suzuki7, Masayoshi Uraoka8, Naozumi Shibata9, Sanae Nakamura10, Satoshi Imamine11, Hidehiro Murakami3, Katsuhisa Ohashi12, Masamoto Torisu13, Makoto Yano14, Aki Hasebe15, Harumi Yano16, Masato Murakami17, Eiji Takeshita18, Yoshio Ikeda19, Yoichi Hiasa1. 1. Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan. 2. Health Services Center, Ehime University, Matsuyama, Bunkyo, Ehime, Japan. shinya.furukawa@gmail.com. 3. Department of Internal Medicine, Saiseikai Matsuyama Hospital, Yamanishi, Matsuyama, Ehime, Japan. 4. Department of Gastroenterology, Ehime Prefectural Central Hospital, Kasuga, Matsuyama, Ehime, Japan. 5. Department of Internal Medicine, Saiseikai Imabari Hospital, Kita, Imabari, Ehime, Japan. 6. Department of Gastroenterology, Matsuyama Shimin Hospital, Ote, Matsuyama, Ehime, Japan. 7. Department of Gastroenterology, Sumitomo Besshi Hospital, Oji, Niihama, Ehime, Japan. 8. Uraoka Gastrointestinal Clinic, Ishite, Matsuyama, Ehime, Japan. 9. Department of Gastroenterology, Ehime Prefectural Niihama Hospital, Hongo, Niihama, Ehime, Japan. 10. Department of Gastroenterology, Shinsenkai Matsuyama Madonna Hospital, Kiyo, Matsuyama, Ehime, Japan. 11. Department of Internal Medicine, Shiritsu Oozu Hospital, Nishioozu, Oozu, Ehime, Japan. 12. Ohashi Clinic Participate in Gastro-Enterology and Ano-Proctology, Funaki, Niihama, Ehime, Japan. 13. Department of Internal Medicine, Saiseikai Saijo Hospital, Tsuitachi, Saijo, Ehime, Japan. 14. Yano Clinic, Higashinagato, Matsuyama, Ehime, Japan. 15. Department of Gastroenterology, Shikoku Cancer Center, Minamiumenomoto, Matsuyama, Ehime, Japan. 16. Department of Gastroenterology, Saijo City Shuso Hospital, Nyugawa, Saijo, Ehime, Japan. 17. Department of Gastroenterology, Murakamikinen Hospital, Oomachi, Saijo, Ehime, Japan. 18. Department of Inflammatory Bowel Diseases and Therapeutics, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan. 19. Endoscopy Center, Ehime University Hospital, Shitsukawa, Toon, Ehime, Japan.
Abstract
BACKGROUND: Serum globulin is an inflammation marker. To date, no evidence regarding the association between serum globulin and disease activity in patients with ulcerative colitis has been reported. AIMS: We evaluated the association between serum globulin and endoscopic activity in patients with ulcerative colitis. METHODS: Serum globulin was divided into tertiles based on the distribution of study subjects (low globulin, ≤ 2.7 g/dl (reference); moderate globulin, 2.7-3.1 g/dl; and high globulin, > 3.1 g/dl). A single endoscopic specialist evaluated the endoscopic findings, and mucosal healing was based on Mayo endoscopic subscore. RESULTS: A total of 277 patients with ulcerative colitis were included in the study. Serum globulin was independently positively associated with diminished or absent vascular markings [moderate: adjusted odds ratio (OR) 3.70 (95% confidence interval, CI: 1.82-7.88) and high: adjusted OR 2.40 (95%CI: 1.20-4.94), p for trend = 0.005]. A similar positive association between globulin and erosion was found [high: adjusted OR 2.00 (95%CI: 1.05-3.86)]. Serum globulin was independently inversely associated with mucosal healing [moderate: adjusted OR 0.37 (95%CI: 0.18-0.73) and high: adjusted OR 0.31 (95%CI: 0.14-0.64), p for trend = 0.001] and adjusted partial mucosal healing [moderate: OR 0.51 (95%CI: 0.26-0.98), p for trend = 0.048]. The inverse association between globulin and mucosal healing was significant in the low but not the high C-reactive protein group. CONCLUSIONS: In patients with ulcerative colitis, serum globulin was significantly positively associated with endoscopic activity, and was significantly inversely associated with mucosal healing, especially in the low C-reactive protein group.
BACKGROUND: Serum globulin is an inflammation marker. To date, no evidence regarding the association between serum globulin and disease activity in patients with ulcerative colitis has been reported. AIMS: We evaluated the association between serum globulin and endoscopic activity in patients with ulcerative colitis. METHODS: Serum globulin was divided into tertiles based on the distribution of study subjects (low globulin, ≤ 2.7 g/dl (reference); moderate globulin, 2.7-3.1 g/dl; and high globulin, > 3.1 g/dl). A single endoscopic specialist evaluated the endoscopic findings, and mucosal healing was based on Mayo endoscopic subscore. RESULTS: A total of 277 patients with ulcerative colitis were included in the study. Serum globulin was independently positively associated with diminished or absent vascular markings [moderate: adjusted odds ratio (OR) 3.70 (95% confidence interval, CI: 1.82-7.88) and high: adjusted OR 2.40 (95%CI: 1.20-4.94), p for trend = 0.005]. A similar positive association between globulin and erosion was found [high: adjusted OR 2.00 (95%CI: 1.05-3.86)]. Serum globulin was independently inversely associated with mucosal healing [moderate: adjusted OR 0.37 (95%CI: 0.18-0.73) and high: adjusted OR 0.31 (95%CI: 0.14-0.64), p for trend = 0.001] and adjusted partial mucosal healing [moderate: OR 0.51 (95%CI: 0.26-0.98), p for trend = 0.048]. The inverse association between globulin and mucosal healing was significant in the low but not the high C-reactive protein group. CONCLUSIONS: In patients with ulcerative colitis, serum globulin was significantly positively associated with endoscopic activity, and was significantly inversely associated with mucosal healing, especially in the low C-reactive protein group.