On behalf of my co-authors, I would like to thank Drs Halpin and Hamlin for commenting on our recent article.[1, 2] They correctly point out that retrospective observational studies such as ours are subject to a number of limitations, including fixed sample size, type II errors and variability in individual patients’ treatment and investigations. These were acknowledged in the Discussion section of our article. We can also reassure Drs Halpin and Hamlin that the decision to dose escalate was not made on the basis of ‘irritable bowel syndrome’ but on assessment of clinical, biochemical and endoscopic parameters by experienced gastroenterologists with a tertiary referral inflammatory bowel diseases practice.
The lessons from our study for gastroenterologists are twofold. First, the need for dose escalation is frequent in this patient cohort, as has been noted by other groups.[3, 4] Secondly, and which has not been reported previously, patients with ulcerative colitis who need dose escalation may have inferior clinical outcomes to those who can be maintained on standard therapy. We agree that additional studies will shed more light on this question.