Clinical Impact of Gastrointestinal Multiplex PCR Panels on Relapse Prediction in Ulcerative Colitis: A Prospective One-Year Follow-up Study

Clinical Impact of Gastrointestinal Multiplex PCR Panels on Relapse Prediction in Ulcerative Colitis: A Prospective One-Year Follow-up Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical Impact of Gastrointestinal Multiplex PCR Panels on Relapse Prediction in Ulcerative Colitis: A Prospective One-Year Follow-up Study Merve Buyukkoruk, Ozlem Guzel Tunccan, Selin Yigit, Ali Karatas, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9023219/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Background: This study aimed to evaluate the effect of the gastrointestinal system multiplex PCR panel (GISP) on the relapse-free survival of ulcerative colitis (UC) both active and in remission patients. Methods: In this prospective single-center study, adult patients with ulcerative colitis were followed for one year. Baseline disease activity was assessed using the Partial Mayo Score (PMS). Gastrointestinal multiplex PCR panel testing was performed, and the association between PCR positivity and relapse-free survival was analyzed using survival models. Results: At baseline 74.1% of patients were in remission and 25.9% were in the active period. At least one causative agent was detected in 39.7% of stool samples evaluated by GISP. The most common agents were Enteropathogenic E. coli (EPEC) (52.2%), Campylobacter spp. (13.8%), and Enteroaggregative E. coli (EAEC) (11.6%). There was no difference between patients in baseline remission and relapse groups regarding agent positivity. A relapse developed in 38.5% of the patients within one year follow-up. There was no difference between relapse-free survival in GISP positive and negative patients. In patients who were active at baseline, the relapse-free period was shorter. As a result of the study, the most critical factor affecting the relapse-free period was the partial Mayo score (PMS), which we used to determine the activity status of the disease at baseline. Conclusion: According to the results of the study, GISP positivity did not affect relapse-free survival. The role of GISP in UC patients' follow-up and predicting clinical outcomes of patients in relapse or remission was limited. Gastrointestinal panels GIS multiplex panel GISP Ulcerative colitis Figures Figure 1 Figure 2 Figure 3 Introduction Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) with an increasing global prevalence, particularly in industrialized and developing regions(1). Alterations in the intestinal microbiota, characterized by dysbiosis and increased pathogen burden, are central to UC pathogenesis and may influence disease activation and clinical outcomes. Moreover, infectious gastroenteritis and UC flares often present with overlapping clinical features, complicating diagnostic and therapeutic decision-making. Distinguishing between these entities is critical, as management strategies differ substantially. Therefore, stool-based testing for enteric pathogens is a fundamental component of the initial evaluation of UC patients presenting with symptoms suggestive of disease(2). As an alternative to standard microbiological methods, the gastrointestinal system multiplex polymerase chain reaction (PCR) panels (GISP) are widely used. These tests enable the simultaneous detection of bacterial, viral, and parasitic pathogens from a single stool sample, typically within a period of one hour. However, the high sensitivity of PCR limits its ability to differentiate between viable and nonviable organisms, thereby preventing accurate distinction between infection and colonization. This represents a major limitation of GISPs (3). Therefore, despite their widespread use, there is still no consensus on the effects of GİSPs on chronic GI diseases such as IBD (2). While some studies have reported that GISP use in patients with IBD is associated with reduced treatment escalation(2,3),others have demonstrated potential drawbacks, including prolonged hospital stays, unnecessary antibiotic exposure, and delays in appropriate diagnosis and treatment due to misattribution of symptoms to infection (2,4). Notably, most available data has been derived from cohorts of symptomatic patients. This study included patients with UC in both the active disease and remission at baseline prospectively evaluated the clinical impact of GISP. The primary objective was to investigate the association between GISP positivity and relapse-free survival over a year follow-up period. Methods Study Design and Population This single-center, prospective, observational study with a cross-sectional baseline assessment was conducted between October 2022 and May 2024. Adult patients (³18 years old), with a confirmed diagnosis of UC, including both newly diagnosed and those under routine follow-up, were eligible for inclusion. Pregnancy, prior total colectomy, receipt of active immunosuppressive therapy unrelated to ulcerative colitis management, and the presence of acquired immunodeficiency were exclusion criteria. Definitions A partial Mayo score ≥3 at the time of admission was considered active disease (5). Relapse (flare) during follow-up was defined as one of the following: (i) development of a PMS ≥3 in patients who were in remission at baseline; (ii) non-response to initial UC therapy or secondary loss of response in patients with active disease (PMS≥3) or newly diagnosed UC; or (iii) UC-related rehospitalization outside of routine follow-up in patients being monitored for active disease. Statistical Analyses Statistical analyses were performed using Jamovi version 2.5.3. The normality of variables was examined using visual (histograms and probability plots) and analytical methods (Kolmogorov-Smirnov/Shapiro Wilk tests). Non-normally distributed variables are presented as median and interquartile range (IQR), while normally distributed data are presented as mean and standard deviation. Chi-square or Fisher's exact tests were used to compare categorical variables. Continuous variable comparisons were performed using the Student's t-test for normally distributed data and the Mann-Whitney U test for non-normally distributed data. The relationship between GISP positivity, EPEC and Campylobacter spp. positivity, and PMS on day 0 with relapse-free days was evaluated using Kaplan-Meier survival analyses and the log-rank test. Cox regression models were created to evaluate the factors affecting attack-free days. Variables with p<0.05 in univariate analyses and those that could be clinically significant but did not show high correlation (rho<0.75) with each other (day 0 disease activity, multiplex PCR result, hemoglobin, CRP, and UC duration) were included in the model. The proportional hazard assumptions for each categorical variable were assessed using graphs. Cases where the Type-1 error value was <0.05 were considered statistically significant results. Sample Size Calculation Based on a study by Hanada and et al., the one year relapse rate was 11% in PCR positive patients and 37% in PCR negative patients with IBD(6). Assuming these proportions, a two-sided type I error of 0.05 and a type II error of 0.20 (80% power), a minimum of 42 patients was required in each group. Previous studies have reported PCR positivity rates in patients with IBD ranging from 17% to 26% (7). Assuming an estimated prevalence of 23%, a total sample size of 182 patients (±10%) was planned to ensure the inclusion of at least 42 PCR-positive individuals. This study was supported by the Scientific Research Projects Unit of Gazi University under project code TTU-2022-7898. Results At the end of the sample collection period a total of 241 patients were included in the study. Stool samples were obtained from 191 of the patients. After excluding repeated samples from the same patient and samples deemed to be invalid after microbiological examination, a total of 174 patients were included in the analyses. Demographic and clinical characteristics of patients included in the study are presented in Table 1. Table 1. Demographic and clinical characteristics of patients included in the study Age, median (IQR %25-75) 44 (30-59) Sex, female, n (%) 74 (41.4) UC duration(years) median (IQR %25-75) 6 (2-10) Change in treatment due to attack, n (%) 15 (8.6) Colectomy, n (%) 6 (3.4) Antibiotic use in the last 6 months, n (%) 40 (23.0) History of attacks in the last 6 months, n (%) 63 (36.2) Treatment group, n (%) No treatment 10 (5.7) Monotherapy 95 (54.6) Combination therapy 69 (39.7) UC treatment, n ( %) 5- ASA² 137 (78.7) Azathioprine 36 (20.7) Anti-TNF ³ 32 (18.4) Monoclonal antibody⁴ 24 (13.8) Corticosteroid ² 18 (10.3) Janus kinase inhibitors - Disease status (Day 0), n (%) Remission 129 (74.1) Active 45(25.9) Clinical findings (Day 0)n (%) Abdominal pain 21 (12.1) Weight loss 13 (7.5) Disorder of oral intake 8 (4.6) Vomiting 2 (1.1) Fever 1 (0.6) Stool frequency, median (IQR 25-75%) 2 (2-4) Colitis-related complaints 56 (32.2) Extraintestinal symptoms 12 (6.9) Laboratory findings (Day 0), median (IQR 25-75%) WBC, mm 3 7250 (6100- 8800) Hemoglobin, g/dL 13.8 (12.5-14.9) Platelet, x 10 3 /mm 3 275 (224-338) AST, U/L 20 (17-25) ALT, U/L 20 (15-29.5) Total billirubin, mg/dL 0.53 (0.42-0.76) Albumin, g/dL 4.4 (4.2-4.7) Creatinine, mg/dL 0.74 (0.64-0.89) CRP, mg/dL 4 (2.4 – 9.6) ESR, mm/h 16 (9-33) Endoscopic evaluation in the last 6 months,, n (%) 85 (48.9) Endoscopic finding, n (%) 1 Remission 31 (36.5) Active 54 (63.5) Endoscopic site, n (%) 1 No finding 19 (22.4) Proctitis (E1) 31 (36.5) Distal (E2) 24 (28.2) Pancolitis(E3) 11 (12.9) EAI, median (IQR%25-75) 1 8 (2-10) MES, median (IQR%25-75) 1 2 (0-3) Stool frequency (last 3 days) ,n (%) Normal 112 (64.4) 1-2 stools/day than normal 27 (15.5) 3-4 stools/day than normal 16 (9.2) ≥5 stools/day than normal 19 (10.9) Rectal bleeding (last 3 days), n (%) None 138 (79.3) Visible blood with stool less than half time 13 (7.5) Visible blood with stool half of the time or more 21 (12.1) Passing blood alone 2 (1.19) Physician rating of disease activity, n (%) Normal 126 (72.4) Mild 22 (12.6) Moderate 16 (9.2) Severe 10 (5.7) PMS, n (%) Remission (<3) 129 (74.1) Mild (3-4) 22 (12.6) Moderate (5-6) 11 (6.3) Severe (≥7) 12 (6.9) 85 patients were evaluated. Local or systemic Infliximab, adalimumab, sertolizumab Vedolizumab, ustekinumab, guselkimab Abbreviations: ESR;eritrosit sedimentation rate, EAI;endoscopic activity index, MES; Mayo endoscopic score,PMS;partial Mayo score All patients underwent pathogen testing of stool samples via GISP. At least one pathogen was detected in 69 of the 174 stool samples (39.7%). At the time of the evaluation, at least one pathogen was identified by GISP in 40.3% (n=52/129) of patients in remission and 37.8% (n=17/45) of active patients (p=0.860). Patients with and without identified pathogens were compared, and the results are presented in Table 2. Table 2. Comparison of patients according to GISP results GISP positive, n=69 GISP negative, n=105 P value Age, median (IQR %25-75) 41.0 (29.0-58.0) 47.0 (33.0-59.0) 0.209 Sex, female, n (%) 22 (31.9) 50 (47.6) 0.042 UC duration(years) median (IQR %25-75) 6 (2.0-10.0) 7 (3.0-10.0) 0.318 History of attacks in the last 6 months, n (%) 27 (39.1) 36 (34.3) 0.524 Antibiotic use in the last 6 months, n (%) 16 (23.2) 24 (22.9) 1.00 Disease status (Day 0), n (%) Remission 52 (75.4) 77 (73.3) 0.860 Active 17 (24.6) 28 (26.7) PMS, median (IQR%25-75) 0 (0-2) 0 (0-3) 0.724 EAI, median (IQR%25-75) 1 8.0 (2-10) 7.5 (1.5-10.0) 0.928 Endoscopic site, n (%) 1 No finding 8 (21.6) 11(22.9) >0.999 * Proctitis 13(35.1) 18 (37.5) Distal 10 (27.0) 14 (29.2) Pancolitis 6 (16.2) 5 (10.4) UC treatment, n (%) 5- ASA² 50 (72.5) 87 (82.9) 0.130 Azathioprine 14 (20.3) 22 (21) 1.00 Anti-TNF³ 16 (23.2) 16 (15.2) 0.231 Monoclonal antibody⁴ 10 (14.5) 14 (13.3) 0.826 Corticosteroid² 10 (14.5) 8 (7.6) 0.203 Treatment group, n (%) No therapy 4 (5.8) 6 (5.7) >0.999 * Monotherapy 36 (52.2) 59 (56.2) Combination therapy 29 (42.0) 40 (38.1) Flare(within 1 year) 30 (35.2) 37 (43.5) 0.275 Hospitalization (within 1 year), n (%) 3 (4.3) 11 (10.3) 0.167 Colectomy (within 1 year), n (%) 1 (1.4) 1 (1.0) 1.00 Mortality (within 1 year), n (%) 1 (2.6) 1 (1.4) 1.00 85 patients were evaluated. Local or systemic Infliximab, adalimumab, sertolizumab Vedolizumab, ustekinumab, guselkimab *Corrected by Bonferroni adjustment Abbreviations: EAI;endoscopic activity index, PMS;partial Mayo score The pathogens detected in patients with positive GISP and their distribution according to disease activity at the time of testing were evaluated. (Figure 1) . The most frequently detected pathogens were EPEC at 52.2% (n=36), Campylobacter spp. at 13.8% (n=24), and EAEC at 11.6% (n=8). (Table 3) . Table 3. Distribution of pathogens in remission and active patient groups Pathogen, n (%) Total Remission, n=52 Active, n=17 p value Sapovirus - - - - Adenovirus 1 1(0.8) - n/a Astrovirus - - - - Norovirus 4 2 (1.6) 2 (4.4) 0.275 Rotavirus - - - - EPEC 36 30 (23.3) 6 (13.3) 0.157 EAEC 8 8(6.2) - n/a ETEC 3 3(2.3) - n/a STEC 6 4(3.1) 2(4.4) 0.649 EIEC - - - - Yersinia enterocolitica - - - - Campylobacter spp. 24 18(14.0) 6(13.3) 0.917 Salmonella spp. - - - - Vibrio parahaemolyticus - - - - Vibrio cholerae - - - - Plseiomonas spp. - - - - C. difficile toksin A - - - - C. difficile toksin B - - - - C. difficile toksin AB 2 1 (0.8) 1(2.2) 0.451 Giardia lamblia 2 1 (0.8) 1 (2.2) 0.451 Entamoeba histolytica 2 1 (0.8) 1 (2.2) 0.451 Cryptosporidium spp. 2 2 (1.6) - n/a Cyclospora spp. - - - - Enteroinvasive pathogens 1 33 24 (18.6) 9 (20.0) 0.837 Polymicrobial 19 18(14.0) 1(2.2) 0.028 1 Campylobacter spp., Salmonella spp., EAEC , STEC, EIEC , Yersinia enterocolitica , Vibrio parahaemolyticus, Entamoeba histolytica , C. difficile toxin AB. In our study, multiple pathogens were identified at once in 19 among the 174 patients (11%). EPEC in 41.7%, Campylobacter spp. in 41.7%, EAEC in 50%, STEC in 50% ve ETEC in 66.7% were detected as part of polymicrobial positivity. All parasitic positivity was polymicrobial. C. difficile and viral pathogens were, on the other hand, detected as single pathogens in all cases. The median cycle treshold(CT) values for the entirely polymicrobial parasitic agents were as follows: Giardia lamblia 25.3 (IQR 24.9-25.7), Entamoeba histolytica 25.7 (IQR 25.4-26), and Cryptosporidium spp. 23.3 (IQR 22.7-24). The CT values of EPEC, Campylobacter spp., and EAEC, the three main pathogens in our study, were assessed for each pathogen in the remission and active groups on day 0, revealing no significant difference.When these pathogens were categorized as high positive (CT ≤26) and low positive (CT >26), also no significant difference was found in the remission and active patient groups on the day 0. (Supplementary). Direct stool microscopy and culture examination were performed in 72 (41.4%) patients. In the direct microscopic examination, leukocytes and erythrocytes weren't present in 41 (56.9%) of the patients. Leukocytes were detected in all fields in 14 (19.4%) patients, leukocytes and erythrocytes were detected in 16 (22.2%) patients, and only erythrocytes were detected in 1 (1.4%) patient. Salmonella spp. and Shigella spp. were not detected in the culture examination of the patients. In prospective follow-ups flare occured in 67 patients (38.5%) within the course of one year. Patients with and without flare were compared and presented in Table 4. Table 4. Comparision of patiets with and without flare within 6 months With flare, n=67 Without flare, n=107 P value Age, median (IQR 25-75%) 38.0 (29.0-55.0) 48.0 (33.5-60.0) 0.036 Sex, female, n (%) 48.0 (33.5-60.0) 45 (42.1) 0.819 UC duration , (IQR 25-75%) 4.0 (2.0-9.0) 7.0 (3.0-10.0) 0.027 Active disease (Day0), n (%) 28 (41.8) 17 (15.9) 0.001 History of attacks in the last 6 months, n (%) 39 (58.2) 24 (22.4) <0.001 Treatment, n (%) 5- ASA 1 52 (77.6) 85 (79.4) 0.774 Azathioprine 14 (20.9) 22 (20.6) 0.958 Anti-TNF² 13 (19.4) 19 (17.8) 0.785 Monoclonal antibody³ 14 (20.9) 10 (9.3) 0.032 Corticosteroid 1 13 (19.4) 5 (4.7) 0.002 Treatment group, n (%) No therapy 1(2.7) 9 (6.6) >0.999* Monotherapy 18 (48.6) 77(56.2) Combination therapy 18 (48.6) 51(38.2) EAI, median (IQR 25-75%) ⁴ 9 (7.5-10.0) 5 (0-10.0) 0.004 Endoscopic site, n (%)⁴ No finding - 19 (29.7) 0.042* E-1 8 (38.1) 23 (35.9) E-2 8 (38.1) 16 (25.0) E-3 5 (23.8) 6 (9.4) Pancolitis, n (%) 5 (23.8) 6 (9.4) 0.087 PMS (Day0), median (IQR, %25-75) 1 (0.0-4.0) 0 (0.0-1.0) <0.001 WBC, mm 3 (Day0) 7600 (6600-10000) 7100 (6000-8400) 0.077 Hemoglobin(Day0), g/dL, 13.6 (12.4-14.4) 13.8 (12.9-15.0) 0.076 CRP (Day0), mg/dL, 6.3 (3.0-18.4) 3.41 (2.43-6.14) 0.002 ESR (Day0), mm/hours 22.0 (11.0-44.5) 15.0 (9.0-27.0) 0.022 GISP positive, n (%) 30 (44.8) 39 (36.4) 0.275 Polymicrobial,n (%) 9 (13.4) 10 (9.3) 0.400 Enteroinvasive pathogen, n (%) 16 (23.9) 17 (15.9) 0.191 EPEC 14 (20.9) 22 (20.6) 0.958 Camplybacte r spp. 13 (19.4) 11 (10.3) 0.089 EAEC 4 (6.0) 4 (3.7) 0.494 Local or systemic İnfliximab, adalimumab,sertolizumab Vedolizumab, ustekinumab,guselkimab 85 patients were evaluated. *Corrected by Bonferroni adjustment. Abbreviations: ESR;eritrosit sedimentation rate, EAI;endoscopic activity index,PMS;partial Mayo score The median time to development of an attack or re-attack during the one year follow-up period was determined to be 174 days, with a range of 19 to 364 days. The time to onset of attacks did not differ between GISP positive and GISP negative patients, with durations of 193 days (91-313) and 168 days (141-266) respectively (p=0.860, log-rank test). (Figure 2) No relationship was identified between EPEC [(97 days (25-177) vs. 73.5 days (19-162), Log-rank, p=0.497)], Camplybacter spp. [(77 days (28-175) vs. 93,5 days (19-177), Log-rank, p=0,966)] and EAEC attacks [(84 days (19-177) vs. 131days (116-146) Log-rank, p=0.844)] positivity and time to onset of attacks. No relationship was found between the detection of multiple pathogens and the time of attack development [(154 days (28-180) vs. 164 days (19-180) Log-rank, p=0.517)]. Patients with active disease at baseline had a shorter duration of attack-free days. [(82,5 days (25-176) vs. 108 days (19-177)), Log-rank, p<0,001)]. A model created to assess factors affecting attack-free days during follow-up included disease activity on day 0 (HR: 2.02 (1.17-3.49), p=0.011), GISP positivity (HR: 1.24 (0.76-2.02), p=0.395), age (HR: 0.99 (0.93-1.02), p=0.163), UC duration (HR: 0.98, 0.93-1.02, p=359), and CRP (HR: 1.02 (1.01-1.02), p=0.001). R² = 0.487, likelihood ratio, p < 0.001 (Figure 3). Discussion Ulcerative colitis is a relapsing–remitting disease, with reported 1-year relapse rates ranging from 13.7% to 58%(8–11). In the present study, the 1-year relapse rate was 38.5%, consistent with previous reports. A key strength of this study is the inclusion of patients in both remission and active disease at baseline. Notably, approximately one-third of patients who were in clinical remission experienced a relapse within one year, suggesting that clinical remission alone may not fully reflect underlying disease activity or long-term prognosis. The most significant finding of this study is that simple clinical tools, specifically the Partial Mayo Score (PMS), remain far superior to costly molecular diagnostic panels (GISP) in predicting one-year relapse-free survival in Ulcerative Colitis (UC). Baseline disease activity (PMS ≥3) more than doubled the risk of relapse (HR:2.02). This reinforces the principle that "symptom control" is not merely a quality-of-life goal but the most reliable indicator of long-term prognosis in UC management. Ulcerative colitis (UC) and gastrointestinal infections exhibit a bidirectional relationship. While mucosal barrier dysfunction and immunosuppressive therapy increase infection susceptibility in UC, enteric pathogens may also influence disease activity and prognosis (12). Despite this two-way relationship, our study found no significant association between GISP positivity and relapse duration. The fact that detection rates for the most common pathogens (EPEC and Campylobacter spp .) were nearly identical between patients in remission and those with active disease is a critical observation. These findings suggest that the microorganisms detected are likely "pathobionts" (opportunistic resident flora) rather than "true pathogens" (acute infection). The similarity in Cycle Threshold (Ct) values across both groups serves as strong evidence for this hypothesis. High Ct values, indicating a low bacterial load, suggest that PCR panels often detect subclinical "colonization" that does not necessarily drive the underlying inflammatory process. The widespread use of GISP panels in UC patients introduces a significant risk of misattribution. Detecting Campylobacter or E. coli species may lead clinicians toward unnecessary antibiotic therapy rather than the essential optimization of UC-specific immunosuppressive or biologic treatments. In our cohort, almost all patients with polymicrobial positivity (multiple pathogens) were in clinical remission. This highlights that a positive GISP result, in the absence of a correlating clinical syndrome, should be viewed as asymptomatic carriage rather than an actionable infection. The primary limitation of this study is the lack of routine endoscopic confirmation (Mayo Endoscopic Score) for every identified relapse. However, from the perspectives of real-world evidence and cost-effectiveness, non-invasive markers such as PMS and CRP remain the cornerstone of clinical practice. Future research should shift from qualitative (Positive/Negative) to quantitative (Ct-based load analysis) reporting of GISP results. This distinction could help clinicians differentiate between a transient "hitchhiker" and a pathogen that truly threatens mucosal stability. Conclusion Baseline clinical activity (PMS) remains the strongest predictor of relapse in UC, while pathogen detection via GISP shows no significant impact on disease course. GISP positivity should be interpreted with caution and primarily regarded as colonization unless strongly supported by the clinical context. Declarations Conflict of interest: The authors declare no conflict of interest. Funding: This study was supported by Gazi University Scientific Research Project Unit with the project code TTU-2022-7898. Ethics approval and consent to participate: The study protocol was approved by the Gazi University Clinical Research Ethics Committee (approval date: May 16, 2022; approval number 357). Informed consent to participate was obtained from all of the participants in the study. This study complies with the Helsinki Declaration. Consent for publication: Not applicable. Funding: This study was supported by Gazi University Scientific Research Project Unit with the project code TTU-2022-7898. Acknowledgement The authors would like to thank Senay Ucan, the nurse of the inflammatory bowel disease outpatient clinic, for her contributions. Authors Contributions Methodology, M.B.,O.G.T.,M.D.,M.A.; paitent selection, M.B.,A.K.,T.K.;anaylsis of samples, S.Y.,G.B.;statistical analysis, M.B.; writing, M.B.,O.G.T,S.Y,G.B. Data Availability The data underlying this article are available in the article. References Ng SC, Shi HY, Hamidi N, Underwood FE, Tang W, Benchimol EI, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. The Lancet. 2017 Dec;390(10114):2769–78. doi:10.1016/S0140-6736(17)32448-0 Ahmad W, Nguyen NH, Boland BS, Dulai PS, Pride DT, Bouland D, et al. Comparison of Multiplex Gastrointestinal Pathogen Panel and Conventional Stool Testing for Evaluation of Diarrhea in Patients with Inflammatory Bowel Diseases. Dig Dis Sci. 2019 Feb;64(2):382–90. doi:10.1007/s10620-018-5330-y Hong S, Zaki TA, Main M, Hine AM, Chang S, Hudesman D, et al. Comparative Evaluation of Conventional Stool Testing and Multiplex Molecular Panel in Outpatients With Relapse of Inflammatory Bowel Disease. Inflammatory Bowel Diseases. 2021 Oct 1;27(10):1634–40. doi:10.1093/ibd/izaa336 Axelrad JE, Freedberg DE, Whittier S, Greendyke W, Lebwohl B, Green DA. Impact of Gastrointestinal Panel Implementation on Health Care Utilization and Outcomes. Journal of Clinical Microbiology. 2019 Feb 27;57(3):10.1128/jcm.01775-18. doi:10.1128/jcm.01775-18 Suzuki Y, Motoya S, Hanai H, Hibi T, Nakamura S, Lazar A, et al. Four-year maintenance treatment with adalimumab in Japanese patients with moderately to severely active ulcerative colitis. J Gastroenterol. 2017;52(9):1031–40. doi:10.1007/s00535-017-1325-2 PubMed PMID: 28321512; PubMed Central PMCID: PMC5569655. Hanada Y, Khanna S, Loftus EV, Raffals LE, Pardi DS. Non–Clostridium difficile Bacterial Infections Are Rare in Patients With Flares of Inflammatory Bowel Disease. Clinical Gastroenterology and Hepatology. 2018 Apr 1;16(4):528–33. doi:10.1016/j.cgh.2017.10.008 PubMed PMID: 29037938. Axelrad JE, Joelson A, Green PHR, Lawlor G, Lichtiger S, Cadwell K, et al. Enteric Infections Are Common in Patients with Flares of Inflammatory Bowel Disease. American Journal of Gastroenterology. 2018 Oct;113(10):1530–9. doi:10.1038/s41395-018-0211-8 Yoon H, Jangi S, Dulai PS, Boland BS, Prokop LJ, Jairath V, et al. Incremental Benefit of Achieving Endoscopic and Histologic Remission in Patients With Ulcerative Colitis: A Systematic Review and Meta-Analysis. Gastroenterology. 2020 Oct;159(4):1262-1275.e7. doi:10.1053/j.gastro.2020.06.043 Pandey A, Achrafie L, Kodjamanova P, Tencer T, Kumar J. Endoscopic mucosal healing and histologic remission in ulcerative colitis: a systematic literature review of clinical, quality-of-life and economic outcomes. Current Medical Research and Opinion. 2022 Sep 2;38(9):1531–41. doi:10.1080/03007995.2022.2081453 Naegeli AN, Hunter T, Dong Y, Hoskin B, Middleton-Dalby C, Hetherington J, et al. Full, Partial, and Modified Permutations of the Mayo Score: Characterizing Clinical and Patient-Reported Outcomes in Ulcerative Colitis Patients. Crohn’s & Colitis 360. 2021 Jan 1;3(1):otab007. doi:10.1093/crocol/otab007 Azad S, Sood N, Sood A. Biological and Histological Parameters as Predictors of Relapse in Ulcerative Colitis: A Prospective Study. Saudi J Gastroenterol. 2011;17(3):194–8. doi:10.4103/1319-3767.80383 PubMed PMID: 21546723; PubMed Central PMCID: PMC3122090. Tu KC, Yu RY, Lin YH, Chien CC, Lu CL. Bidirectional association between infectious gastroenteritis and inflammatory bowel disease: a population-based study. Eur J Med Res. 2023 Sep 11;28(1):337. doi:10.1186/s40001-023-01324-y Additional Declarations No competing interests reported. Supplementary Files supplementary.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 29 Apr, 2026 Reviews received at journal 26 Apr, 2026 Reviews received at journal 26 Apr, 2026 Reviews received at journal 23 Apr, 2026 Reviewers agreed at journal 18 Apr, 2026 Reviewers agreed at journal 17 Apr, 2026 Reviewers agreed at journal 16 Apr, 2026 Reviewers agreed at journal 15 Apr, 2026 Reviewers invited by journal 07 Apr, 2026 Editor assigned by journal 06 Apr, 2026 Editor invited by journal 17 Mar, 2026 Submission checks completed at journal 16 Mar, 2026 First submitted to journal 16 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9023219","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":620085514,"identity":"50af9b6c-dc98-4abc-a159-ad47a8468968","order_by":0,"name":"Merve Buyukkoruk","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEElEQVRIiWNgGAWjYDCCAxAqAYiZGRuApAQ7iDSwIEULD0jIQIIULRIgNgNuLXy3Tyc+rmyzyTO4kWNsOKPiXuLMmc+vbvhRIMHA396dgE2L5LnczYZn29KKQVoSN5wpTpwtnVN2swfoMIkzZzdg02JwhnebZMOZw4kbgFoOPmxLSJwnnZN2gweoxUAiF5eW7T8bzvxH0iJ5Ju3mH/xatjE2VBwAa0ncCNQyW4L92G18tkie4d0s2VCRXCx55lmx4YwzCcYze3LYbssYSPDg8gvfGd6NHxsM7PL4jidvluypSJCdcfz4s5tv/tjI8bf3YtWCAAIJMBaPAZjErxwE+A/AWOwPCKseBaNgFIyCkQQA2b5uWWs0qM4AAAAASUVORK5CYII=","orcid":"","institution":"Manisa Soma State Hospital","correspondingAuthor":true,"prefix":"","firstName":"Merve","middleName":"","lastName":"Buyukkoruk","suffix":""},{"id":620085515,"identity":"929574eb-3106-4686-bdd4-f57beb62f072","order_by":1,"name":"Ozlem Guzel Tunccan","email":"","orcid":"","institution":"Gazi University Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ozlem","middleName":"Guzel","lastName":"Tunccan","suffix":""},{"id":620085516,"identity":"519bde52-3590-4a87-8ca2-53ba04cc13f3","order_by":2,"name":"Selin Yigit","email":"","orcid":"","institution":"Gazi University Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Selin","middleName":"","lastName":"Yigit","suffix":""},{"id":620085517,"identity":"eec9642a-8827-43cf-b525-a9d040f863be","order_by":3,"name":"Ali Karatas","email":"","orcid":"","institution":"Gazi University Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ali","middleName":"","lastName":"Karatas","suffix":""},{"id":620085518,"identity":"fc5ddd3e-d15b-486c-b091-4205780059b6","order_by":4,"name":"Tarkan Karakan","email":"","orcid":"","institution":"Gazi University Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Tarkan","middleName":"","lastName":"Karakan","suffix":""},{"id":620085519,"identity":"7c13052f-bf44-4571-b7ca-d17b2e7f528e","order_by":5,"name":"Mehmet Arhan","email":"","orcid":"","institution":"TOBB ETU Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mehmet","middleName":"","lastName":"Arhan","suffix":""},{"id":620085520,"identity":"d0e12d73-b1a4-4a75-831b-a55a6610d7f2","order_by":6,"name":"Murat Dizbay","email":"","orcid":"","institution":"Gazi University Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Murat","middleName":"","lastName":"Dizbay","suffix":""},{"id":620085521,"identity":"347413f0-ec53-4d43-a220-60c839fdbb22","order_by":7,"name":"Gulendam Bozdayi","email":"","orcid":"","institution":"Gazi University Faculty of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Gulendam","middleName":"","lastName":"Bozdayi","suffix":""}],"badges":[],"createdAt":"2026-03-03 19:08:46","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9023219/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9023219/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106870212,"identity":"0228f38c-e059-4313-9202-964d4932c165","added_by":"auto","created_at":"2026-04-14 09:41:49","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":53227,"visible":true,"origin":"","legend":"\u003cp\u003eDistrubution of pathogens\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9023219/v1/4dbfc287a8cb5d51fa141c43.jpg"},{"id":106870208,"identity":"8d513eab-dc29-4729-9d8d-67d7d4c9f7ac","added_by":"auto","created_at":"2026-04-14 09:41:49","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":48390,"visible":true,"origin":"","legend":"\u003cp\u003eThe effect of GISP positivity on attack free survival\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9023219/v1/a9ee76246e630c628a4734dc.jpg"},{"id":106870067,"identity":"76c246cf-47ab-4bfd-ac66-90cfe4639c0b","added_by":"auto","created_at":"2026-04-14 09:41:31","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":46348,"visible":true,"origin":"","legend":"\u003cp\u003eAttack free survival forest plot\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9023219/v1/7a026a733000bf468b22be8c.jpg"},{"id":106870938,"identity":"73e0aae4-5f6b-412f-ae82-d5fbc5fe6945","added_by":"auto","created_at":"2026-04-14 09:44:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1006962,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9023219/v1/2f4f9d0b-4e31-4ebb-8112-6840e9621acb.pdf"},{"id":106870495,"identity":"34b01127-6c32-44cc-82d6-b6b0a49b3d33","added_by":"auto","created_at":"2026-04-14 09:42:48","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":14409,"visible":true,"origin":"","legend":"","description":"","filename":"supplementary.docx","url":"https://assets-eu.researchsquare.com/files/rs-9023219/v1/ff9af542125ac3fd4a4ab3ce.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical Impact of Gastrointestinal Multiplex PCR Panels on Relapse Prediction in Ulcerative Colitis: A Prospective One-Year Follow-up Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eUlcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) with an increasing global prevalence, particularly in industrialized and developing regions(1).\u0026nbsp;Alterations in the intestinal microbiota, characterized by dysbiosis and increased pathogen burden, are central to UC pathogenesis and may influence disease activation and clinical outcomes. Moreover, infectious gastroenteritis and UC flares often present with overlapping clinical features, complicating diagnostic and therapeutic decision-making. Distinguishing between these entities is critical, as management strategies differ substantially. Therefore, stool-based testing for enteric pathogens is a fundamental component of the initial evaluation of UC patients presenting with symptoms suggestive of disease(2).\u003c/p\u003e\n\u003cp\u003eAs an alternative to standard microbiological methods, the gastrointestinal system multiplex polymerase chain reaction (PCR) panels (GISP) are widely used. These tests enable the simultaneous detection of bacterial, viral, and parasitic pathogens from a single stool sample, typically within a period of one hour. However, the high sensitivity of PCR limits its ability to differentiate between viable and nonviable organisms, thereby preventing accurate distinction between infection and colonization. This represents a major limitation of GISPs (3). Therefore, despite their widespread use, there is still no consensus on the effects of GİSPs on chronic GI diseases such as IBD\u0026nbsp;(2). While some studies have reported that GISP use in patients with IBD is associated with reduced treatment escalation(2,3),others have demonstrated potential drawbacks, including prolonged hospital stays, unnecessary antibiotic exposure, and delays in appropriate diagnosis and treatment due to misattribution of symptoms to infection (2,4). Notably, most available data has been derived from cohorts of symptomatic patients.\u003c/p\u003e\n\u003cp\u003eThis study included patients with UC in both the active disease and remission at baseline prospectively evaluated the clinical impact of GISP. The primary objective was to investigate the association between GISP positivity and relapse-free survival over a year follow-up period.\u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis single-center, prospective, observational study with a cross-sectional baseline assessment was conducted between October 2022 and May 2024. Adult patients (\u0026sup3;18 years old), with a confirmed diagnosis of UC, including both newly diagnosed and those under routine follow-up, were eligible for inclusion.\u0026nbsp;Pregnancy, prior total colectomy, receipt of active immunosuppressive therapy unrelated to ulcerative colitis management, and the presence of acquired immunodeficiency were exclusion criteria.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDefinitions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA partial Mayo score \u0026ge;3 at the time of admission was considered active disease\u0026nbsp;(5). Relapse (flare) during follow-up was defined as one of the following:\u003cbr\u003e\u0026nbsp;(i) development of a PMS \u0026ge;3 in patients who were in remission at baseline;\u003cbr\u003e\u0026nbsp;(ii) non-response to initial UC therapy or secondary loss of response in patients with active disease (PMS\u0026ge;3) or newly diagnosed UC; or\u003cbr\u003e\u0026nbsp;(iii) UC-related rehospitalization outside of routine follow-up in patients being monitored for active disease.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analyses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analyses were performed using Jamovi version 2.5.3. The normality of variables was examined using visual (histograms and probability plots) and analytical methods (Kolmogorov-Smirnov/Shapiro Wilk tests). Non-normally distributed variables are presented as median and interquartile range (IQR), while normally distributed data are presented as mean and standard deviation. Chi-square or Fisher\u0026apos;s exact tests were used to compare categorical variables. Continuous variable comparisons were performed using the Student\u0026apos;s t-test for normally distributed data and the Mann-Whitney U test for non-normally distributed data. The relationship between GISP positivity, EPEC and Campylobacter spp. positivity, and PMS on day 0 with relapse-free days was evaluated using Kaplan-Meier survival analyses and the log-rank test.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCox regression models were created to evaluate the factors affecting attack-free days. Variables with p\u0026lt;0.05 in univariate analyses and those that could be clinically significant but did not show high correlation (rho\u0026lt;0.75) with each other (day 0 disease activity, multiplex PCR result, hemoglobin, CRP, and UC duration) were included in the model. The proportional hazard \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;assumptions for each categorical variable were assessed using graphs. Cases where the Type-1 error value was \u0026lt;0.05 were considered statistically significant results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size Calculation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Based on a study by Hanada and et al., the one year relapse rate was 11% in PCR positive patients and 37% in PCR negative patients with IBD(6).\u0026nbsp;Assuming these proportions, a two-sided type I error of 0.05 and a type II error of 0.20 (80% power), a minimum of 42 patients was required in each group. Previous studies have reported PCR positivity rates in patients with IBD ranging from 17% to 26%\u0026nbsp;(7).\u0026nbsp;Assuming an estimated prevalence of 23%, a total sample size of 182 patients (\u0026plusmn;10%) was planned to ensure the inclusion of at least 42 PCR-positive individuals.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThis study was supported by the Scientific Research Projects Unit of Gazi University under project code TTU-2022-7898.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAt the end of the sample collection period a total of 241 patients were included in the study. Stool samples were obtained from 191 of the patients. After excluding repeated samples from the same patient and samples deemed to be invalid after microbiological examination, a total of 174 patients were included in the analyses.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eDemographic and clinical characteristics of patients included in the study are presented in Table 1.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 1. Demographic and clinical\u0026nbsp;characteristics of patients included in the study\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eAge, median (IQR %25-75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e44 (30-59)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eSex, female, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e74 (41.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eUC duration(years) median (IQR %25-75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e6 (2-10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eChange in treatment due to attack, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e15 (8.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eColectomy, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e6 (3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eAntibiotic use in the last 6 months, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e40 (23.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eHistory of attacks in the last 6 months, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e63 (36.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eTreatment group, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e10 (5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Monotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e95 (54.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Combination therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e69 (39.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eUC treatment, n ( %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 5- ASA\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e137 (78.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Azathioprine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e36 (20.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Anti-TNF \u0026sup3;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e32 (18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Monoclonal antibody⁴\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e24 (13.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Corticosteroid \u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e18 (10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Janus kinase inhibitors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eDisease status (Day 0), n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Remission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e129 (74.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Active\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e45(25.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eClinical findings (Day 0)n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Abdominal pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e21 (12.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Weight loss\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e13 (7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Disorder of oral intake\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e8 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Vomiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e2 (1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Fever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e1 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eStool frequency, median (IQR 25-75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e2 (2-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eColitis-related complaints\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e56 (32.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eExtraintestinal symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e12 (6.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eLaboratory findings (Day 0), median (IQR 25-75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;WBC, mm\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e7250 (6100- 8800)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Hemoglobin, g/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e13.8 (12.5-14.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Platelet, x 10 \u003csup\u003e3\u003c/sup\u003e/mm\u003csup\u003e\u0026nbsp;3\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e275 (224-338)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;AST, U/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e20 (17-25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;ALT, U/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e20 (15-29.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Total billirubin, mg/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e0.53 (0.42-0.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Albumin, g/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e4.4 (4.2-4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Creatinine, mg/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e0.74 (0.64-0.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;CRP, mg/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e4 (2.4 \u0026ndash; 9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;ESR, mm/h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e16 (9-33)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eEndoscopic evaluation in the last 6 months,, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e85 (48.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eEndoscopic finding, n (%) \u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Remission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e31 (36.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Active\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e54 (63.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eEndoscopic site, n (%)\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No finding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e19 (22.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Proctitis (E1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e31 (36.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Distal (E2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e24 (28.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Pancolitis(E3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e11 (12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eEAI,\u0026nbsp;median (IQR%25-75)\u003csup\u003e\u0026nbsp;1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e8 (2-10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eMES, median (IQR%25-75) \u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e2 (0-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eStool frequency (last 3 days) ,n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Normal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e112 (64.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;1-2 stools/day than normal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e27 (15.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;3-4 stools/day than normal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e16 (9.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026ge;5 stools/day than normal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e19 (10.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eRectal bleeding (last 3 days), n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;None\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e138 (79.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Visible blood with stool less than half time\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e13 (7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Visible blood with stool half of the time or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e21 (12.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Passing blood alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e2 (1.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003ePhysician rating of disease activity, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Normal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e126 (72.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Mild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e22 (12.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Moderate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e16 (9.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Severe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e10 (5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003ePMS, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Remission (\u0026lt;3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e129 (74.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Mild (3-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e22 (12.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Moderate (5-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u0026nbsp;11 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Severe (\u0026ge;7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e12 (6.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 604px;\"\u003e\n \u003col\u003e\n \u003cli\u003e85 patients were evaluated.\u003c/li\u003e\n \u003cli\u003eLocal or systemic\u003c/li\u003e\n \u003cli\u003eInfliximab, adalimumab, sertolizumab\u003c/li\u003e\n \u003cli\u003eVedolizumab, ustekinumab, guselkimab\u003c/li\u003e\n \u003c/ol\u003e\n \u003cp\u003eAbbreviations: ESR;eritrosit sedimentation rate, EAI;endoscopic activity index, MES; Mayo endoscopic score,PMS;partial Mayo score\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients underwent pathogen testing of stool samples via GISP. At least one pathogen was detected in 69 of the 174 stool samples (39.7%). At the time of the evaluation, at least one pathogen was identified by GISP in 40.3% (n=52/129) of patients in remission and 37.8% (n=17/45) of active patients (p=0.860).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatients with and without identified pathogens were compared, and the results are presented in Table 2.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2. Comparison of patients according to GISP results\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"528\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGISP positive,\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=69\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGISP negative,\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=105\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eAge, median (IQR %25-75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e41.0 (29.0-58.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e47.0 (33.0-59.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.209\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eSex, female, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e22 (31.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e50 (47.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eUC duration(years) median (IQR %25-75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e6 (2.0-10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7 (3.0-10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.318\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eHistory of attacks in the last 6 months, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e27 (39.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e36 (34.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.524\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eAntibiotic use in the last 6 months, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e16 (23.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e24 (22.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 528px;\"\u003e\n \u003cp\u003eDisease status (Day 0), n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Remission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e52 (75.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e77 (73.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.860\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Active\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e17 (24.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e28 (26.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003ePMS, median (IQR%25-75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0 (0-2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0 (0-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.724\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eEAI,\u0026nbsp;median (IQR%25-75)\u003csup\u003e\u0026nbsp;1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e8.0 (2-10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7.5 (1.5-10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.928\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 528px;\"\u003e\n \u003cp\u003eEndoscopic site, n (%)\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No finding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e8 (21.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e11(22.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003ch3\u003e\u0026gt;0.999 *\u003c/h3\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Proctitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e13(35.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e18 (37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Distal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e10 (27.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e14 (29.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Pancolitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e6 (16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e5 (10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 528px;\"\u003e\n \u003cp\u003eUC treatment, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;5- ASA\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e50 (72.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e87 (82.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.130\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Azathioprine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e14 (20.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e22 (21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Anti-TNF\u0026sup3;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e16 (23.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e16 (15.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.231\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003ch3\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Monoclonal antibody⁴\u003c/h3\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e10 (14.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e14 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.826\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Corticosteroid\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e10 (14.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8 (7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.203\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 528px;\"\u003e\n \u003cp\u003eTreatment group, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; No therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e4 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e6 (5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026gt;0.999 *\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Monotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e36 (52.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e59 (56.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Combination therapy\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e29 (42.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e40 (38.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eFlare(within 1 year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e30 (35.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e37 (43.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.275\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eHospitalization (within 1 year), n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e3 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e11 (10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.167\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eColectomy (within 1 year), n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1 (1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eMortality (within 1 year), n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1 (2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1 (1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 528px;\"\u003e\n \u003col\u003e\n \u003cli\u003e85 patients were evaluated.\u003c/li\u003e\n \u003cli\u003eLocal or systemic\u003c/li\u003e\n \u003cli\u003eInfliximab, adalimumab, sertolizumab\u003c/li\u003e\n \u003cli\u003eVedolizumab, ustekinumab, guselkimab\u0026nbsp;\u003c/li\u003e\n \u003c/ol\u003e\n \u003cp\u003e*Corrected by Bonferroni adjustment\u003c/p\u003e\n \u003cp\u003eAbbreviations: EAI;endoscopic activity index, PMS;partial Mayo score\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe pathogens detected in patients with positive GISP and their distribution according to disease activity at the time of testing were evaluated. \u003cstrong\u003e(Figure 1)\u003c/strong\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe most frequently detected pathogens were EPEC at 52.2% (n=36), \u003cem\u003eCampylobacter\u003c/em\u003e spp. at 13.8% (n=24), and EAEC at 11.6% (n=8).\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e(Table 3)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eTable 3. Distribution of pathogens in remission and active patient groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePathogen, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRemission, n=52\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eActive,\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=17\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eSapovirus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eAdenovirus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1(0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003en/a\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eAstrovirus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eNorovirus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e4\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e2 (4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.275\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eRotavirus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eEPEC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e36\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 30 (23.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e6 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.157\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eEAEC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e8\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8(6.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003en/a\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eETEC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e3\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3(2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003en/a\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eSTEC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e6\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4(3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e2(4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.649\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eEIEC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cem\u003eYersinia enterocolitica\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cem\u003eCampylobacter\u003c/em\u003e spp.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e24\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e18(14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e6(13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.917\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cem\u003eSalmonella\u003c/em\u003e spp.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cem\u003eVibrio parahaemolyticus\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eVibrio cholerae\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cem\u003ePlseiomonas\u003c/em\u003e spp.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cem\u003eC. difficile\u003c/em\u003e toksin A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cem\u003eC. difficile\u003c/em\u003e toksin B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cem\u003eC. difficile\u003c/em\u003e toksin AB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e1(2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.451\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eGiardia lamblia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e1 (2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.451\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cem\u003eEntamoeba histolytica\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e1 (2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.451\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cem\u003eCryptosporidium\u0026nbsp;\u003c/em\u003espp.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003en/a\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u003cem\u003eCyclospora\u0026nbsp;\u003c/em\u003espp.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eEnteroinvasive pathogens\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e33\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e24 (18.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e9 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.837\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003ePolymicrobial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e19\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e18(14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e1(2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 528px;\"\u003e\n \u003cp\u003e\u003csup\u003e1\u003c/sup\u003e\u003cem\u003e\u0026nbsp;Campylobacter\u003c/em\u003e spp., \u003cem\u003eSalmonella\u003c/em\u003e spp., EAEC\u003cem\u003e,\u0026nbsp;\u003c/em\u003eSTEC, EIEC\u003cem\u003e, Yersinia enterocolitica\u003c/em\u003e, \u003cem\u003eVibrio parahaemolyticus, Entamoeba histolytica\u003c/em\u003e, \u003cem\u003eC. difficile\u003c/em\u003e toxin AB.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eIn our study, multiple pathogens were identified at once in 19 among the 174 patients (11%). EPEC in 41.7%, \u003cem\u003eCampylobacter\u003c/em\u003e spp. in 41.7%, EAEC in 50%, STEC in 50% ve ETEC in 66.7% were detected as part of polymicrobial positivity. All parasitic positivity was polymicrobial. \u003cem\u003eC. difficile\u003c/em\u003e and viral pathogens were, on the other hand, detected as single pathogens in all cases. \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe median cycle treshold(CT) values for the entirely polymicrobial parasitic agents were as follows: \u003cem\u003eGiardia lamblia\u003c/em\u003e 25.3 (IQR 24.9-25.7), \u003cem\u003eEntamoeba histolytica\u003c/em\u003e 25.7 (IQR 25.4-26), and \u003cem\u003eCryptosporidium\u0026nbsp;\u003c/em\u003espp. 23.3 (IQR 22.7-24). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe CT values of EPEC, \u003cem\u003eCampylobacter\u003c/em\u003e spp., and EAEC, the three main pathogens in our study, were assessed for each pathogen in the remission and active groups on day 0, revealing no significant difference.When these pathogens were categorized as high positive (CT \u0026le;26) and low positive (CT \u0026gt;26), also no significant difference was found in the remission and active patient groups on the day 0. (Supplementary).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eDirect stool microscopy and culture examination were performed in 72 (41.4%) patients. In the direct microscopic examination, leukocytes and erythrocytes weren\u0026apos;t present in 41 (56.9%) of the patients. Leukocytes were detected in all fields in 14 (19.4%) patients, leukocytes and erythrocytes were detected in 16 (22.2%) patients, and only erythrocytes were detected in 1 (1.4%) patient. \u003cem\u003eSalmonella\u0026nbsp;\u003c/em\u003espp. and \u003cem\u003eShigella\u0026nbsp;\u003c/em\u003espp. were not detected in the culture examination of the patients.\u003c/p\u003e\n\u003cp\u003eIn prospective follow-ups flare occured in 67 patients (38.5%) within the course of one year. Patients with and without flare were compared and presented in Table 4.\u003c/p\u003e\n\u003cp\u003eTable 4. Comparision of patiets with and without flare within 6 months\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWith flare,\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=67\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithout flare,\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=107\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eAge, median\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(IQR 25-75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e38.0 (29.0-55.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e48.0 (33.5-60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eSex, female, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e48.0 (33.5-60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e45 (42.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.819\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eUC duration , (IQR 25-75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4.0 (2.0-9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e7.0 (3.0-10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eActive disease (Day0), n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e28 (41.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e17 (15.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eHistory of attacks in the last 6 months, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e39 (58.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e24 (22.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 528px;\"\u003e\n \u003cp\u003eTreatment, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;5- ASA\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e52 (77.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e85 (79.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.774\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Azathioprine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e14 (20.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e22 (20.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.958\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Anti-TNF\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e13 (19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e19 (17.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.785\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Monoclonal antibody\u0026sup3;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e14 (20.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e10 (9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Corticosteroid\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e13 (19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e5 (4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 528px;\"\u003e\n \u003cp\u003eTreatment group, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; No therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1(2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e9 (6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026gt;0.999*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Monotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e18 (48.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e77(56.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Combination therapy\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e18 (48.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e51(38.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eEAI,\u0026nbsp;median (IQR 25-75%) ⁴\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e9 (7.5-10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e5 (0-10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 528px;\"\u003e\n \u003cp\u003eEndoscopic site, n (%)⁴\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No finding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e19 (29.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.042*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;E-1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8 (38.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e23 (35.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;E-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8 (38.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e16 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;E-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e5 (23.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e6 (9.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003ePancolitis, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e5 (23.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e6 (9.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003ePMS (Day0), median (IQR, %25-75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1 (0.0-4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0 (0.0-1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eWBC,\u0026nbsp;mm\u003csup\u003e3\u0026nbsp;\u003c/sup\u003e(Day0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7600 (6600-10000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e7100 (6000-8400)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.077\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eHemoglobin(Day0), g/dL,\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e13.6 (12.4-14.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e13.8 (12.9-15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eCRP (Day0), mg/dL,\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e6.3 (3.0-18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.41 (2.43-6.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eESR\u0026nbsp;(Day0),\u0026nbsp;mm/hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;22.0 (11.0-44.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e15.0 (9.0-27.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eGISP positive, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e30 (44.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e39 (36.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.275\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003ePolymicrobial,n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e9 (13.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e10 (9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.400\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eEnteroinvasive pathogen, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e16 (23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e17 (15.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.191\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eEPEC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e14 (20.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e22 (20.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.958\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cem\u003eCamplybacte\u003c/em\u003er spp.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e13 (19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e11 (10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.089\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eEAEC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4 (6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4 (3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.494\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 528px;\"\u003e\n \u003col\u003e\n \u003cli\u003eLocal or systemic\u003c/li\u003e\n \u003cli\u003eİnfliximab, adalimumab,sertolizumab\u003c/li\u003e\n \u003cli\u003eVedolizumab, ustekinumab,guselkimab\u003c/li\u003e\n \u003cli\u003e85 patients were evaluated.\u003c/li\u003e\n \u003c/ol\u003e\n \u003cp\u003e*Corrected by Bonferroni adjustment.\u003c/p\u003e\n \u003cp\u003eAbbreviations: ESR;eritrosit sedimentation rate, EAI;endoscopic activity index,PMS;partial Mayo score\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe median time to development of an attack or re-attack during the one year follow-up period was determined to be 174 days, with a range of 19 to 364 days. The time to onset of attacks did not differ between GISP positive and GISP negative patients, with durations of 193 days (91-313) and 168 days (141-266) respectively (p=0.860, log-rank test). (Figure 2)\u003c/p\u003e\n\u003cp\u003eNo relationship \u0026nbsp; was identified between EPEC [(97 days (25-177) vs. 73.5 days (19-162), Log-rank, p=0.497)],\u0026nbsp;\u003cem\u003eCamplybacter\u003c/em\u003e spp. [(77 days (28-175) vs. 93,5 days (19-177), Log-rank, p=0,966)] and EAEC attacks [(84 days (19-177) vs. 131days (116-146) Log-rank, p=0.844)] positivity and time to onset of attacks.\u003c/p\u003e\n\u003cp\u003eNo relationship was found between the detection of multiple pathogens and the time of attack development [(154 days (28-180) vs. 164 days (19-180) Log-rank, p=0.517)].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatients with active disease at baseline had a shorter duration of attack-free days. [(82,5 days (25-176) vs. 108 days (19-177)), Log-rank, p\u0026lt;0,001)].\u003c/p\u003e\n\u003cp\u003eA model created to assess factors affecting attack-free days during follow-up included disease activity on day 0 (HR: 2.02 (1.17-3.49), p=0.011), GISP positivity (HR: 1.24 (0.76-2.02), p=0.395), age (HR: 0.99 (0.93-1.02), p=0.163), UC duration (HR: 0.98, 0.93-1.02, p=359), and CRP (HR: 1.02 (1.01-1.02), p=0.001). R\u0026sup2; = 0.487, likelihood ratio, p \u0026lt; 0.001 (Figure 3).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eUlcerative colitis is a relapsing\u0026ndash;remitting disease, with reported 1-year relapse rates ranging from 13.7% to 58%(8\u0026ndash;11).\u0026nbsp;\u0026nbsp;In the present study, the 1-year relapse rate was 38.5%, consistent with previous reports. A key strength of this study is the inclusion of patients in both remission and active disease at baseline. Notably, approximately one-third of patients who were in clinical remission experienced a relapse within one year, suggesting that clinical remission alone may not fully reflect underlying disease activity or long-term prognosis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe most significant finding of this study is that simple clinical tools, specifically the Partial Mayo Score (PMS), remain far superior to costly molecular diagnostic panels (GISP) in predicting one-year relapse-free survival in Ulcerative Colitis (UC). Baseline disease activity (PMS \u0026ge;3) more than doubled the risk of relapse (HR:2.02). This reinforces the principle that \u0026quot;symptom control\u0026quot; is not merely a quality-of-life goal but the most reliable indicator of long-term prognosis in UC management.\u003c/p\u003e\n\u003cp\u003eUlcerative colitis (UC) and gastrointestinal infections exhibit a bidirectional relationship. While mucosal barrier dysfunction and immunosuppressive therapy increase infection susceptibility in UC, enteric pathogens may also influence disease activity and prognosis\u0026nbsp;(12). \u0026nbsp;Despite this two-way relationship, our study found no significant association between GISP positivity and relapse duration. The fact that detection rates for the most common pathogens (EPEC and \u003cem\u003eCampylobacter spp\u003c/em\u003e.) were nearly identical between patients in remission and those with active disease is a critical observation. These findings suggest that the microorganisms detected are likely \u0026quot;pathobionts\u0026quot; (opportunistic resident flora) rather than \u0026quot;true pathogens\u0026quot; (acute infection). The similarity in Cycle Threshold (Ct) values across both groups serves as strong evidence for this hypothesis. High Ct values, indicating a low bacterial load, suggest that PCR panels often detect subclinical \u0026quot;colonization\u0026quot; that does not necessarily drive the underlying inflammatory process.\u003c/p\u003e\n\u003cp\u003eThe widespread use of GISP panels in UC patients introduces a significant risk of misattribution. Detecting \u003cem\u003eCampylobacter\u003c/em\u003e or \u003cem\u003eE. coli\u003c/em\u003e species may lead clinicians toward unnecessary antibiotic therapy rather than the essential optimization of UC-specific immunosuppressive or biologic treatments. In our cohort, almost all patients with polymicrobial positivity (multiple pathogens) were in clinical remission. This highlights that a positive GISP result, in the absence of a correlating clinical syndrome, should be viewed as asymptomatic carriage rather than an actionable infection.\u003c/p\u003e\n\u003cp\u003eThe primary limitation of this study is the lack of routine endoscopic confirmation (Mayo Endoscopic Score) for every identified relapse. However, from the perspectives of real-world evidence and cost-effectiveness, non-invasive markers such as PMS and CRP remain the cornerstone of clinical practice. Future research should shift from qualitative (Positive/Negative) to quantitative (Ct-based load analysis) reporting of GISP results. This distinction could help clinicians differentiate between a transient \u0026quot;hitchhiker\u0026quot; and a pathogen that truly threatens mucosal stability.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBaseline clinical activity (PMS) remains the strongest predictor of relapse in UC, while pathogen detection via GISP shows no significant impact on disease course. GISP positivity should be interpreted with caution and primarily regarded as colonization unless strongly supported by the clinical context.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis study was supported by Gazi University Scientific Research Project Unit with the project code TTU-2022-7898.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003eThe study protocol was approved by the Gazi University Clinical Research Ethics Committee (approval date: May 16, 2022; approval number 357). Informed consent to participate was obtained from all of the participants in the study. This study complies with the Helsinki Declaration.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not applicable. \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis study was supported by Gazi University Scientific Research Project Unit with the project code TTU-2022-7898.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank Senay Ucan, the nurse of the inflammatory bowel disease outpatient clinic, for her contributions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMethodology, M.B.,O.G.T.,M.D.,M.A.; paitent selection, M.B.,A.K.,T.K.;anaylsis of samples, S.Y.,G.B.;statistical analysis, M.B.; writing, M.B.,O.G.T,S.Y,G.B.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data underlying this article are available in the article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eNg SC, Shi HY, Hamidi N, Underwood FE, Tang W, Benchimol EI, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. The Lancet. 2017 Dec;390(10114):2769\u0026ndash;78. doi:10.1016/S0140-6736(17)32448-0\u003c/li\u003e\n\u003cli\u003eAhmad W, Nguyen NH, Boland BS, Dulai PS, Pride DT, Bouland D, et al. Comparison of Multiplex Gastrointestinal Pathogen Panel and Conventional Stool Testing for Evaluation of Diarrhea in Patients with Inflammatory Bowel Diseases. Dig Dis Sci. 2019 Feb;64(2):382\u0026ndash;90. doi:10.1007/s10620-018-5330-y\u003c/li\u003e\n\u003cli\u003eHong S, Zaki TA, Main M, Hine AM, Chang S, Hudesman D, et al. Comparative Evaluation of Conventional Stool Testing and Multiplex Molecular Panel in Outpatients With Relapse of Inflammatory Bowel Disease. Inflammatory Bowel Diseases. 2021 Oct 1;27(10):1634\u0026ndash;40. doi:10.1093/ibd/izaa336\u003c/li\u003e\n\u003cli\u003eAxelrad JE, Freedberg DE, Whittier S, Greendyke W, Lebwohl B, Green DA. Impact of Gastrointestinal Panel Implementation on Health Care Utilization and Outcomes. Journal of Clinical Microbiology. 2019 Feb 27;57(3):10.1128/jcm.01775-18. doi:10.1128/jcm.01775-18\u003c/li\u003e\n\u003cli\u003eSuzuki Y, Motoya S, Hanai H, Hibi T, Nakamura S, Lazar A, et al. Four-year maintenance treatment with adalimumab in Japanese patients with moderately to severely active ulcerative colitis. J Gastroenterol. 2017;52(9):1031\u0026ndash;40. doi:10.1007/s00535-017-1325-2 PubMed PMID: 28321512; PubMed Central PMCID: PMC5569655.\u003c/li\u003e\n\u003cli\u003eHanada Y, Khanna S, Loftus EV, Raffals LE, Pardi DS. Non\u0026ndash;Clostridium difficile Bacterial Infections Are Rare in Patients With Flares of Inflammatory Bowel Disease. Clinical Gastroenterology and Hepatology. 2018 Apr 1;16(4):528\u0026ndash;33. doi:10.1016/j.cgh.2017.10.008 PubMed PMID: 29037938.\u003c/li\u003e\n\u003cli\u003eAxelrad JE, Joelson A, Green PHR, Lawlor G, Lichtiger S, Cadwell K, et al. Enteric Infections Are Common in Patients with Flares of Inflammatory Bowel Disease. American Journal of Gastroenterology. 2018 Oct;113(10):1530\u0026ndash;9. doi:10.1038/s41395-018-0211-8\u003c/li\u003e\n\u003cli\u003eYoon H, Jangi S, Dulai PS, Boland BS, Prokop LJ, Jairath V, et al. Incremental Benefit of Achieving Endoscopic and Histologic Remission in Patients With Ulcerative Colitis: A Systematic Review and Meta-Analysis. Gastroenterology. 2020 Oct;159(4):1262-1275.e7. doi:10.1053/j.gastro.2020.06.043\u003c/li\u003e\n\u003cli\u003ePandey A, Achrafie L, Kodjamanova P, Tencer T, Kumar J. Endoscopic mucosal healing and histologic remission in ulcerative colitis: a systematic literature review of clinical, quality-of-life and economic outcomes. Current Medical Research and Opinion. 2022 Sep 2;38(9):1531\u0026ndash;41. doi:10.1080/03007995.2022.2081453\u003c/li\u003e\n\u003cli\u003eNaegeli AN, Hunter T, Dong Y, Hoskin B, Middleton-Dalby C, Hetherington J, et al. Full, Partial, and Modified Permutations of the Mayo Score: Characterizing Clinical and Patient-Reported Outcomes in Ulcerative Colitis Patients. Crohn\u0026rsquo;s \u0026amp; Colitis 360. 2021 Jan 1;3(1):otab007. doi:10.1093/crocol/otab007\u003c/li\u003e\n\u003cli\u003eAzad S, Sood N, Sood A. Biological and Histological Parameters as Predictors of Relapse in Ulcerative Colitis: A Prospective Study. Saudi J Gastroenterol. 2011;17(3):194\u0026ndash;8. doi:10.4103/1319-3767.80383 PubMed PMID: 21546723; PubMed Central PMCID: PMC3122090.\u003c/li\u003e\n\u003cli\u003eTu KC, Yu RY, Lin YH, Chien CC, Lu CL. Bidirectional association between infectious gastroenteritis and inflammatory bowel disease: a population-based study. Eur J Med Res. 2023 Sep 11;28(1):337. doi:10.1186/s40001-023-01324-y\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Gastrointestinal panels, GIS multiplex panel, GISP, Ulcerative colitis ","lastPublishedDoi":"10.21203/rs.3.rs-9023219/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9023219/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: This study aimed to evaluate the effect of the gastrointestinal system multiplex PCR panel (GISP) on the relapse-free survival of ulcerative colitis (UC) both active and in remission patients.\u003c/p\u003e\n\u003cp\u003eMethods: In this prospective single-center study, adult patients with ulcerative colitis were followed for one year. Baseline disease activity was assessed using the Partial Mayo Score (PMS). Gastrointestinal multiplex PCR panel testing was performed, and the association between PCR positivity and relapse-free survival was analyzed using survival models.\u003c/p\u003e\n\u003cp\u003eResults: At baseline 74.1% of patients were in remission and 25.9% were in the active period. At least one causative agent was detected in 39.7% of stool samples evaluated by GISP. The most common agents were Enteropathogenic \u003cem\u003eE. coli\u003c/em\u003e(EPEC) (52.2%), \u003cem\u003eCampylobacter\u003c/em\u003e spp. (13.8%), and Enteroaggregative \u003cem\u003eE. coli\u003c/em\u003e (EAEC) (11.6%). There was no difference between patients in baseline remission and relapse groups regarding agent positivity.\u003c/p\u003e\n\u003cp\u003eA relapse developed in 38.5% of the patients within one year follow-up. There was no difference between relapse-free survival in GISP positive and negative patients. In patients who were active at baseline, the relapse-free period was shorter. As a result of the study, the most critical factor affecting the relapse-free period was the partial Mayo score (PMS), which we used to determine the activity status of the disease at baseline.\u003c/p\u003e\n\u003cp\u003eConclusion: According to the results of the study, GISP positivity did not affect relapse-free survival. The role of GISP in UC patients' follow-up and predicting clinical outcomes of patients in relapse or remission was limited.\u003c/p\u003e","manuscriptTitle":"Clinical Impact of Gastrointestinal Multiplex PCR Panels on Relapse Prediction in Ulcerative Colitis: A Prospective One-Year Follow-up Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-14 09:39:30","doi":"10.21203/rs.3.rs-9023219/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-29T10:50:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-27T00:46:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-26T10:47:44+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-23T09:56:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"16357408732394650164309349498939865171","date":"2026-04-18T11:02:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"306700634386656306832192268569292847792","date":"2026-04-17T22:05:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"55364120580268851525844774217305624557","date":"2026-04-16T16:04:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"162777433509721566212700309224599255369","date":"2026-04-15T06:44:44+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-07T06:32:09+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-06T08:13:12+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-17T18:47:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-16T17:53:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Gastroenterology","date":"2026-03-16T14:30:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"54116fdb-aa8e-4b21-986a-6fb783b584f0","owner":[],"postedDate":"April 14th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-14T09:39:30+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-14 09:39:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9023219","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9023219","identity":"rs-9023219","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}