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patches. However, the types of Peyer’s patches were not associated with the extent of disease involvements, clinical activity, degree of inflammation on endoscopy, or concomitant use of medication. This study revealed several interesting points. It revealed the relationship between small bowel morphological findings of Peyer’s patches and the clinical course of UC, which usually involves the colonic mucosa. Limited attention has been paid to Peyer’s patches in relation to the pathogenesis of UC. The importance of Peyer’s patches is better known in regard to CD than UC. Peyer’s patches are located on the terminal ileum, while UC generally involves the colon and rectum. For this reason, the role of Peyer’s patches in the pathogenesis of UC has rarely been evaluated. However, chronic inflammation from UC can sometimes involve the terminal ileum, which is called backwash colitis. For this reason, we supposed that Peyer’s patches may contribute to the development of UC. The course of UC is unpredictable and repeated relapses of UC can lead to cumulative colonic damage. Continuous clinical follow-ups and UC activity assessments are required to plan a therapeutic strategy. Furthermore, it is very important for doctors to have the precise information that can be used to predict the disease course. Monitoring of the disease course of UC is based on a summation of clinical activity, endoscopic images, radiologic images, serological markers, and fecal markers. There are several variables that may indicate aggressive UC, such as raised levels of perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA), deep ulcerations in the colonic mucosa, lack of mucosal healing after inducEndoscopic evaluation is very important for managing the treatment of patients with UC. Narrow-band imaging (NBI; Olympus, Tokyo, Japan) is an optical endoscopic technique that provides a clearer image of the mucosal layer’s microvascular structure than a routine endoscopy using standard visible light can provide. Because the intramucosal vascular structure can be observed using NBI without applying dye, NBI has mainly been used to diagnose gastrointestinal neoplasm. However, clinical use of NBI for diagnosing UC is uncommon to date, and NBI imaging in UC patients has been used to detect dysplasia in surveillance. Peyer’s patches are aggregated lymphoid follicles surrounded by the follicle-associated epithelium, which contains M cells; they are usually found in the lowest portion of the small intestine, the ileum. Peyer’s patches can transfer luminal antigens and bacteria, and can be considered the immunity gate of the intestine. In the current issue, Hiyama et al. revealed the importance of Peyer’s patches for UC patients. The authors observed Peyer’s patches in the terminal ileums of UC patients using NBI with magnifying endoscopy and categorized the morphology into two groups, the low type and the high type, based on a “villi index.” The duration of time before clinical relapse was shorter in remissive UC patients with high

Can narrow-band imaging of Peyer's patches predict the recurrence of ulcerative colitis?