title: Narrow-band imaging with magnifying endoscopy for Peyer's patches is useful in predicting the recurrence of remissive patients with ulcerative colitis.
abstract: OBJECTIVE
  Peyer's patches (PPs) are aggregates of lymphoid follicles that are mainly located in the distal ileum; they play a major role in mucosal immunity. We recently reported that patients with ulcerative colitis (UC) have alterations in PPs that can be detected using narrow-band imaging with magnifying endoscopy (NBI-ME). However, the usefulness of NBI-ME in UC treatment as a whole is still unknown.
  
  
  METHODS
  We collected NBI-ME images of PPs from 67 UC patients who had undergone ileocolonoscopy. We evaluated changes in the villi using the "villi index," which is based on three categories: irregular formation, hyperemia, and altered vascular network pattern. The patients were divided into two groups on the basis of villi index: low (L)- and high (H)-types. We then determined the correlation between morphological alteration of the PPs and various clinical characteristics. In 52 patients who were in clinical remission, we also analyzed the correlation between NBI-ME findings of PPs and clinical recurrence.
  
  
  RESULTS
  The time to clinical recurrence was significantly shorter in remissive UC patients with H-type PPs than in those with L-type PPs (P<0.01). Moreover, PP alterations were not correlated with age, sex, disease duration, clinical activity, endoscopic score, or extent of disease involvement. Multivariate analysis revealed that the existence of H-type PPs was an independent risk factor for clinical recurrence (hazard ratio, 3.3;P<0.01).
  
  
  CONCLUSIONS
  UC patients with morphological alterations in PPs were at high risk of clinical relapse. Therefore, to predict the clinical course of UC, it may be useful to evaluate NBI-ME images of PPs.
authors: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan.; Department of Therapeutics for Inflammatory Bowel Diseases, Osaka University Graduate School of Medicine, Osaka, Japan.
authors: Satoshi
authors: S
authors: Hiyama
authors: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan.
authors: Hideki
authors: H
authors: Iijima
authors: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan.
authors: Syoichiro
authors: S
authors: Kawai
authors: Department of Gastroenterology, Sumitomo Hospital, Osaka, Japan.
authors: Akira
authors: A
authors: Mukai
authors: Department of Gastroenterology, Sumitomo Hospital, Osaka, Japan.
authors: Eri
authors: E
authors: Shiraishi
authors: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan.
authors: Shuko
authors: S
authors: Iwatani
authors: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan.
authors: Toshio
authors: T
authors: Yamaguchi
authors: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan.
authors: Manabu
authors: M
authors: Araki
authors: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan.
authors: Yoshito
authors: Y
authors: Hayashi
authors: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan.
authors: Shinichiro
authors: S
authors: Shinzaki
authors: Department of Therapeutics for Inflammatory Bowel Diseases, Osaka University Graduate School of Medicine, Osaka, Japan.; Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
authors: Tsunekazu
authors: T
authors: Mizushima
authors: Department of Gastroenterology, Osaka Rosai Hospital, Osaka, Japan.
authors: Masahiko
authors: M
authors: Tsujii
authors: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan.
authors: Tetsuo
authors: T
authors: Takehara
keywords: Colitis, ulcerative; Narrow-band imaging; Peyer's patch