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Clinical scores alone not enough to determine pediatric Crohn’s severity
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Clinical disease activity does not correlate well with endoscopic scoring in children with newly diagnosed Crohn’s disease, therefore clinical disease activity scores should not be used alone to determine disease severity, according to research published in Gastrointestinal Endoscopy.
Nicholas Carman, MBBS, FRACP, from the division of gastroenterology, hepatology and nutrition at Children’s Hospital of Eastern Ontario, and colleagues wrote that as treatment targets are evolving to include mucosal healing, there has been a push to find non-invasive methods to track the progress of this objective.
“Achievement of intestinal healing is particularly important in young patients with CD, given their long life ahead during which disease progression and repeated need for intestinal resection may occur despite achieving clinical remission based on symptomatology,” they wrote. “In contrast to adult CD, however, studies assessing endoscopic severity of disease and correlation with clinical assessment of disease activity have been lacking.”
Investigators assessed data from 280 children aged 17 years and younger diagnosed with CD who were enrolled in an inception cohort at 11 Canadian health centers. They evaluated the patients’ clinical disease activity using the weighted Pediatric Crohn’s Disease Activity Index (wPCDAI) and assessed disease severity at ileocolonoscopy using the Simple Endoscopic Score for Crohn’s disease (SES-CD).
The median wPCDAI was 60 (interquartile range, 40–80; 53% severe), while the median SES-CD was 16 (IQR, 10–22; 51% severe).
Researchers found that the clinical score correlated weakly with endoscopic severity (r = 0.39; P < .001). Even the individual components that make up the wPCDAI had a weak correlation with SES-CD except for stooling, which had a moderate correlation (r = 0.5; P < .001).
Carman and colleagues wrote their findings show that currently available clinical disease activity scores should not be used alone to determine disease severity.
“Clinical assessment remains an essential aspect of routine care in IBD, representing the patient experience of their disease, so the use of appropriate clinical indices remains important,” they wrote. “This should, however, be combined with objective mucosal assessment to monitor treatment outcomes, both in clinic and in the context of clinical trials.” – by Alex Young
Disclosures: Healio Gastroenterology and Liver Disease could not confirm the authors’ relevant financial disclosures prior to publication.
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