Prospective Evaluation of Endoscopic and Histologic Indices in Pediatric Ulcerative Colitis Using Centralized Review.
Journal
The American journal of gastroenterology
ISSN: 1572-0241
Titre abrégé: Am J Gastroenterol
Pays: United States
ID NLM: 0421030
Informations de publication
Date de publication:
01 10 2021
01 10 2021
Historique:
received:
23
01
2021
accepted:
15
07
2021
pubmed:
14
8
2021
medline:
28
10
2021
entrez:
13
8
2021
Statut:
ppublish
Résumé
We aimed to evaluate the reliability and validity of the Ulcerative Colitis (UC) Endoscopic Index of Severity (UCEIS) and Mayo Endoscopy Score (MES) and to validate the Robarts Histopathology Index (RHI) and Nancy Index (NI) in pediatric UC. We examined rectosigmoid and pancolonic versions of each instrument. Single-center cross-sectional study of 60 prospectively enrolled participants. Through central endoscopy review, 4 pediatric gastroenterologists assigned rectosigmoid and pancolonic (mean of 5 colonic segments) UCEIS and MES scores. Two blinded pathologists assigned rectosigmoid and pancolonic RHI and NI scores. We assessed reliability with intraclass correlation coefficients and weighted kappa statistics and explored construct validity with correlations, boxplots, and receiver operator characteristic curves. The UCEIS and MES displayed almost perfect intra-rater and inter-rater reliability (intraclass correlation coefficient and weighted kappa ≥0.85), moderate-to-strong correlation with histologic/clinical activity and fecal calprotectin (FC), and very strong correlation with global endoscopic severity (r > 0.9). Rectosigmoid UCEIS and MES scores of 0 were highly specific (≥95%) for endoscopic and histologic remission throughout the colon. Pancolonic endoscopy scores correlated more strongly with histologic activity, clinical activity, and systemic inflammatory markers and better discriminated between degrees of active disease. RHI and NI showed moderate-to-strong correlation (r = 0.5-0.83) with endoscopic/clinical activity and FC. Our findings support the reliability and construct validity of the UCEIS and MES and the construct validity of the RHI and NI in pediatric UC. Normal rectosigmoid findings predicted pancolonic healing, but, given active disease, pancolonic endoscopic assessment more accurately captured global disease burden.
Identifiants
pubmed: 34388139
doi: 10.14309/ajg.0000000000001400
pii: 00000434-202110000-00020
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2052-2059Subventions
Organisme : CIHR
Pays : Canada
Informations de copyright
Copyright © 2021 by The American College of Gastroenterology.
Références
Shah SC, Colombel JF, Sands BE, et al. Mucosal healing is associated with improved long-term outcomes of patients with ulcerative colitis: A systematic review and meta-analysis. Clin Gastroenterol Hepatol 2016;14(9):1245–55.e8.
Turner D, Ricciuto A, Lewis A, et al. STRIDE-II: An update on the selecting therapeutic targets in inflammatory bowel disease (STRIDE) initiative of the international organization for the study of IBD (IOIBD): Determining therapeutic goals for treat-to-target strategies in IBD. Gastroenterology 2021;160(5):1570–83.
Schroeder KW, Tremaine WJ, Ilstrup DM. Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study. N Engl J Med 1987;317(26):1625–9.
Travis SP, Schnell D, Krzeski P, et al. Developing an instrument to assess the endoscopic severity of ulcerative colitis: The Ulcerative Colitis Endoscopic Index of Severity (UCEIS). Gut 2012;61(4):535–42.
Travis SP, Schnell D, Krzeski P, et al. Reliability and initial validation of the ulcerative colitis endoscopic index of severity. Gastroenterology 2013;145(5):987–95.
Mohammed Vashist N, Samaan M, Mosli MH, et al. Endoscopic scoring indices for evaluation of disease activity in ulcerative colitis. Cochrane Database Syst Rev 2018;1:CD011450.
Benchimol EI, Bernstein CN, Bitton A, et al. Trends in epidemiology of pediatric inflammatory bowel disease in Canada: Distributed network analysis of multiple population-based provincial health administrative databases. Am J Gastroenterol 2017;112(7):1120–34.
Dhaliwal J, Walters TD, Mack DR, et al. Phenotypic variation in paediatric inflammatory bowel disease by age: A multicentre prospective inception cohort study of the Canadian Children IBD Network. J Crohns Colitis 2019;14(4):445–54.
Mosli MH, Feagan BG, Zou G, et al. Development and validation of a histological index for UC. Gut 2017;66(1):50–8.
Marchal-Bressenot A, Salleron J, Boulagnon-Rombi C, et al. Development and validation of the Nancy histological index for UC. Gut 2017;66(1):43–9.
Turner D, Levine A, Escher JC, et al. Management of pediatric ulcerative colitis: Joint ECCO and ESPGHAN evidence-based consensus guidelines. J Pediatr Gastroenterol Nutr 2012;55(3):340–61
Carman N, Tomalty D, Church PC, et al. Clinical disease activity and endoscopic severity correlate poorly in children newly diagnosed with Crohn's disease. Gastrointest Endosc 2019;89(2):364–72.
Ricciuto A, Fish J, Carman N, et al. Symptoms do not correlate with findings from colonoscopy in children with inflammatory bowel disease and primary sclerosing cholangitis. Clin Gastroenterol Hepatol 2018;16(7):1098–105.e1.
Turner D, Otley AR, Mack D, et al. Development, validation, and evaluation of a pediatric ulcerative colitis activity index: A prospective multicenter study. Gastroenterology 2007;133(2):423–32.
Donner A, Eliasziw M. Sample size requirements for reliability studies. Stat Med 1987;6(4):441–8.
Vuitton L, Peyrin-Biroulet L, Colombel JF, et al. Defining endoscopic response and remission in ulcerative colitis clinical trials: An international consensus. Aliment Pharmacol Ther 2017;45(6):801–13.
Pai RK, Khanna R, D'Haens GR, et al. Definitions of response and remission for the Robarts Histopathology Index. Gut 2019;68(11):2101–2.
Mosli MH, Parker CE, Nelson SA, et al. Histologic scoring indices for evaluation of disease activity in ulcerative colitis. Cochrane Database Syst Rev 2017;5:CD011256.
de Jong DC, Lowenberg M, Koumoutsos I, et al. Validation and investigation of the operating characteristics of the ulcerative colitis endoscopic index of severity. Inflamm Bowel Dis 2019;25(5):937–44.
Irani NR, Wang LM, Collins GS, et al. Correlation between endoscopic and histological activity in ulcerative colitis using validated indices. J Crohns Colitis 2018;12(10):1151–7.
Lobatón T, Bessissow T, De Hertogh G, et al. The Modified Mayo Endoscopic Score (MMES): A new index for the assessment of extension and severity of endoscopic activity in ulcerative colitis patients. J Crohns Colitis 2015;9(10):846–52.
Ma R, Meng R, Zhang X, et al. Correlation between fecal calprotectin, ulcerative colitis endoscopic index of severity and clinical outcome in patients with acute severe colitis. Exp Ther Med 2020;20(2):1498–504.
Magro F, Lopes J, Borralho P, et al. Comparing the continuous geboes score with the Robarts histopathology index: Definitions of histological remission and response and their relation to faecal calprotectin levels. J Crohns Colitis 2020;14(2):169–75.
Osterman MT, Scott FI, Fogt FF, et al. Endoscopic and histological assessment, correlation, and relapse in clinically quiescent ulcerative colitis (MARQUEE). Inflamm Bowel Dis 2021;27(2):207–14.
Walsh A, Kormilitzin A, Hinds C, et al. Defining faecal calprotectin thresholds as a surrogate for endoscopic and histological disease activity in ulcerative colitis—A prospective analysis. J Crohns Colitis 2019;13(4):424–30.
Arai M, Naganuma M, Sugimoto S, et al. The ulcerative colitis endoscopic index of severity is useful to predict medium- to long-term prognosis in ulcerative colitis patients with clinical remission. J Crohns Colitis 2016;10(11):1303–9.
Di Ruscio M, Variola A, Vernia F, et al. Role of ulcerative colitis endoscopic index of severity (UCEIS) versus Mayo endoscopic subscore (MES) in predicting patients' response to biological therapy and the need for colectomy. Digestion 2021;102(4):534–45.
Xie T, Zhang T, Ding C, et al. Ulcerative colitis endoscopic index of severity (UCEIS) versus Mayo endoscopic score (MES) in guiding the need for colectomy in patients with acute severe colitis. Gastroenterol Rep 2018;6(1):38–44.
Ikeya K, Hanai H, Sugimoto K, et al. The ulcerative colitis endoscopic index of severity more accurately reflects clinical outcomes and long-term prognosis than the Mayo endoscopic score. J Crohns Colitis 2016;10(3):286–95.