We thank Dr. Gao and Professor Segal for their interest in our paper on abdominal pain and associated factors in patients with ulcerative colitis (UC) [1, 2]. We agree with them regarding the importance of being aware of abdominal pain in patients with UC, including factors associated with gut-brain interaction, in particular anxiety and depression. Additionally, we agree with the suggestion that predictive factors for abdominal pain in UC need to be studied more. Despite these agreements, we would like to clarify why we think that the abdominal pain question of the Gastrointestinal Symptom Rating Scale (GSRS) [3, 4] has an advantage compared to most other questionnaires assessing abdominal pain, despite the fact that the GSRS has a focus on upper rather than lower abdominal pain and discomfort, as we discussed [1].

Importantly, it is difficult to measure the different aspects of chronic abdominal pain that can influence how it is perceived due to interacting peripheral and central mechanisms [5]. The authors of an international guideline on chronic pancreatitis, a disease in which abdominal pain is the most common symptom, stated that the one-dimensional pain intensity ratings alone are insufficient to evaluate chronic abdominal pain [6]. Instead, they suggested using a multidimensional approach including, among others, physical functioning, in combination with abdominal pain intensity scales. With this in mind, we think that rating the bothersomeness of abdominal pain or discomfort, as done in the GSRS, is a more comprehensive approach to assess the multidimensionality of abdominal pain compared to assessing only the severity (i.e. intensity) of the pain, as in most questionnaires including the Ulcerative Colitis Patient-Reported Outcomes Signs and Symptoms [7] referred to by Drs. Gao and Segal.

Future studies are required to investigate gut-brain interaction targeting medical, dietary and psychological therapies in the subgroup of patients with UC and irritable bowel syndrome (IBS)-like symptoms. This is based on the evidence for the role of gut–brain interaction in those with persisting abdominal pain and (quiescent) UC, the impact of IBS-like symptoms, including abdominal pain, on quality of life and the lack of trials investigating treatment strategies targeting gut–brain interaction in patients with UC [1, 8, 9].

我们感谢 Gao 博士和 Segal 教授对我们关于溃疡性结肠炎 （UC） 患者腹痛和相关因素的论文的兴趣 [1， 2]。我们同意他们关于了解 UC 患者腹痛的重要性，包括与肠脑相互作用相关的因素，特别是焦虑和抑郁。此外，我们同意需要更多研究 UC 腹痛预测因素的建议。尽管有这些共识，但我们想澄清为什么我们认为胃肠道症状评定量表 （GSRS） [3， 4] 的腹痛问题与大多数其他评估腹痛的问卷相比具有优势，尽管事实上 GSRS 侧重于上腹痛和不适，而不是下腹痛和不适，正如我们所讨论的 [1]。

重要的是，由于外周和中枢机制的相互作用，很难测量慢性腹痛的不同方面，这些方面会影响其感知方式 [5]。慢性胰腺炎是一种以腹痛为最常见症状的疾病，该国际指南的作者指出，仅凭一维疼痛强度评级不足以评估慢性腹痛 [6]。相反，他们建议使用多维方法，其中包括身体机能，并结合腹痛强度量表。考虑到这一点，我们认为，与 Gao 和 Segal 博士提到的溃疡性结肠炎患者报告的结果体征和症状 [7] 相比，在 GSRS 中所做的对腹痛的烦恼进行评级是一种更全面的评估腹痛多维性的方法。

需要未来的研究来调查针对 UC 和肠易激综合征 （IBS） 样症状患者亚组的药物、饮食和心理治疗的肠脑相互作用。这是基于肠-脑相互作用对持续性腹痛和（静止）UC 患者的作用、IBS 样症状（包括腹痛）对生活质量的影响，以及缺乏调查针对 UC 患者肠-脑相互作用的治疗策略的试验 [1， 8， 9]。