Epithelial Neutrophilic Infiltrate: The Rising Star in Ulcerative Colitis

With great interest, we read the study by Narula et al1 where the central role of epithelial neutrophils in ulcerative colitis (UC) is hypothesized. Several studies have shown that histologic inflammation is a significant risk factor for UC relapse, need for treatment adjustments, surgery, and colorectal cancer.2 The spotlight has moved gradually toward finding the specific microscopic features that are worth searching for. Recent studies show that mucosal neutrophils (in the epithelium and lamina propria) are associated with significantly higher rates of need for corticosteroids or hospitalization, whereas other histologic features were not.