Title: Effect of past extensive ulcers on fecal calprotectin in ulcerative colitis
Version: 0 Date: 01 Sep 2024
Reviewer's report:
The study presents valuable insights into the limitations of using fecal calprotectin (FC) as a
biomarker for ulcerative colitis (UC) patients with past extensive ulcers (PEUs). However, there
are several critical points that need to be addressed to enhance the clarity and robustness of the
conclusions.
1. Microscopic(histologic) Inflammation Consideration:
The observation that FC levels were initially elevated in the PEU group suggests the possibility
of underlying microscopic inflammation, despite the endoscopic remission. This underlying
inflammation might not have been captured by endoscopy but could still influence FC levels.
This is also a point that can be raised based on the results presented in Table 5. The fact that
patients who later experienced relapse had elevated FC values initially might indicate that they
may not have achieved true histological remission at the first place. And as is well known, these
patients would have a higher risk of relapse.
First of all, a discussion regarding this limitation is necessary, as it challenges the study's
assumption that all patients were in true remission.
Second, the conclusion that "the intestinal FC values observed with PEUs in UC may be high,
thus decreasing its usefulness as a biomarker" is somewhat oversimplified. Given the evidence
presented, it would be more accurate to state that FC may not be a reliable biomarker for relapse
prediction in UC patients with endoscopic PEUs due to the potential for underlying microscopic
inflammation. Indeed, the correlation of PEU with underlying inflammation is a novel field
worthy of exploration, and this study succeeds in bringing it to our minds, further pathologic
correlation is warranted for a deeper understanding of the mechanisms behind FC elevation in
PEU patients.
2. Clarification in Line 159:
There is a potential ambiguity in the text (Line 159), where the term "60 patients in the non-
PEU group" seems to refer to the entire cohort of 60 patients encompassing both PEU and non-
PEU groups. This needs to be clearly stated to avoid confusion.
3. Conclusion Refinement:
1) Incorporate Histological Assessments: Future studies should consider including histological
evaluations to detect microscopic inflammation, which could validate the findings and provide
a more comprehensive understanding of the relationship between PEUs and FC levels.
2) Address Bias through Study Design: A more sophisticated study design, possibly involving a
larger sample size and matched controls, could help in disentangling the effects of disease extent
from those of PEUs on FC levels.
Title: Effect of past extensive ulcers on fecal calprotectin in ulcerative colitis
Version: 0 Date: 01 Sep 2024
Reviewer's report:
The study presents valuable insights into the limitations of using fecal calprotectin (FC) as a
biomarker for ulcerative colitis (UC) patients with past extensive ulcers (PEUs). However, there
are several critical points that need to be addressed to enhance the clarity and robustness of the
conclusions.
1. Microscopic(histologic) Inflammation Consideration:
The observation that FC levels were initially elevated in the PEU group suggests the possibility
of underlying microscopic inflammation, despite the endoscopic remission. This underlying
inflammation might not have been captured by endoscopy but could still influence FC levels.
This is also a point that can be raised based on the results presented in Table 5. The fact that
patients who later experienced relapse had elevated FC values initially might indicate that they
may not have achieved true histological remission at the first place. And as is well known, these
patients would have a higher risk of relapse.
First of all, a discussion regarding this limitation is necessary, as it challenges the study's
assumption that all patients were in true remission.
Second, the conclusion that "the intestinal FC values observed with PEUs in UC may be high,
thus decreasing its usefulness as a biomarker" is somewhat oversimplified. Given the evidence
presented, it would be more accurate to state that FC may not be a reliable biomarker for relapse
prediction in UC patients with endoscopic PEUs due to the potential for underlying microscopic
inflammation. Indeed, the correlation of PEU with underlying inflammation is a novel field
worthy of exploration, and this study succeeds in bringing it to our minds, further pathologic
correlation is warranted for a deeper understanding of the mechanisms behind FC elevation in
PEU patients.
2. Clarification in Line 159:
There is a potential ambiguity in the text (Line 159), where the term "60 patients in the non-
PEU group" seems to refer to the entire cohort of 60 patients encompassing both PEU and non-
PEU groups. This needs to be clearly stated to avoid confusion.
3. Conclusion Refinement:
1) Incorporate Histological Assessments: Future studies should consider including histological
evaluations to detect microscopic inflammation, which could validate the findings and provide
a more comprehensive understanding of the relationship between PEUs and FC levels.
2) Address Bias through Study Design: A more sophisticated study design, possibly involving a
larger sample size and matched controls, could help in disentangling the effects of disease extent
from those of PEUs on FC levels.
Please review this paper.
user
Title: Effect of past extensive ulcers on fecal calprotectin in ulcerative colitis
Version: 0 Date: 01 Sep 2024
Reviewer's report:
The study presents valuable insights into the limitations of using fecal calprotectin (FC) as a
biomarker for ulcerative colitis (UC) patients with past extensive ulcers (PEUs). However, there
are several critical points that need to be addressed to enhance the clarity and robustness of the
conclusions.
1. Microscopic(histologic) Inflammation Consideration:
The observation that FC levels were initially elevated in the PEU group suggests the possibility
of underlying microscopic inflammation, despite the endoscopic remission. This underlying
inflammation might not have been captured by endoscopy but could still influence FC levels.
This is also a point that can be raised based on the results presented in Table 5. The fact that
patients who later experienced relapse had elevated FC values initially might indicate that they
may not have achieved true histological remission at the first place. And as is well known, these
patients would have a higher risk of relapse.
First of all, a discussion regarding this limitation is necessary, as it challenges the study's
assumption that all patients were in true remission.
Second, the conclusion that "the intestinal FC values observed with PEUs in UC may be high,
thus decreasing its usefulness as a biomarker" is somewhat oversimplified. Given the evidence
presented, it would be more accurate to state that FC may not be a reliable biomarker for relapse
prediction in UC patients with endoscopic PEUs due to the potential for underlying microscopic
inflammation. Indeed, the correlation of PEU with underlying inflammation is a novel field
worthy of exploration, and this study succeeds in bringing it to our minds, further pathologic
correlation is warranted for a deeper understanding of the mechanisms behind FC elevation in
PEU patients.
2. Clarification in Line 159:
There is a potential ambiguity in the text (Line 159), where the term "60 patients in the non-
PEU group" seems to refer to the entire cohort of 60 patients encompassing both PEU and non-
PEU groups. This needs to be clearly stated to avoid confusion.
3. Conclusion Refinement:
1) Incorporate Histological Assessments: Future studies should consider including histological
evaluations to detect microscopic inflammation, which could validate the findings and provide
a more comprehensive understanding of the relationship between PEUs and FC levels.
2) Address Bias through Study Design: A more sophisticated study design, possibly involving a
larger sample size and matched controls, could help in disentangling the effects of disease extent
from those of PEUs on FC levels.
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