A Systematic Review of Measurement of Endoscopic Disease Activity and Mucosal Healing in Crohnʼs Disease

Khanna, Reena; Bouguen, Guillaume; Feagan, Brian G.; D’Haens, Geert R.; Sandborn, William J.; Dubcenco, Elena; Baker, Kenneth A; Levesque, Barrett G.

doi:10.1097/mib.0000000000000131

Cited by 63 publications

(47 citation statements)

References 93 publications

(75 reference statements)

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“…[1][2][3] The objective of medical treatment has also evolved, from the induction of clinical remission to the healing of mucosal lesions. 4 However, irritable bowel syndrome (IBS) can occur even in the absence of organic abnormalities, and can be associated with gastrointestinal symptoms such as diarrhea and constipation. [5][6][7] Conventionally, IBS and IBD have been considered completely separate diseases.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Irritable Bowel Syndrome-like Symptoms in Japanese Patients with Inactive Inflammatory Bowel Disease

Tomita

Kato

Takimoto

et al. 2016

J Neurogastroenterol Motil

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Background/AimsFew studies are available that have investigated the risk factors for overlapping irritable bowel syndrome (IBS)-like symptoms in patients with inactive inflammatory bowel disease (IBD). The present study has 3 objectives: (1) to assess the prevalence of IBS-like symptoms in Japanese patients with inactive IBD using Rome III criteria, (2) to examine the relationship of IBS-like symptoms to health related quality of life (HR-QOL), and (3) to investigate associations for developing IBS-like symptoms in patients with inactive IBD. MethodsIBS-like symptoms were evaluated using the Rome III questionnaire for functional gastrointestinal disorders. HR-QOL and hospital anxiety and depression scale were evaluated. Results IBS-like symptoms were found in 17.5% (7/40) of patients with inactive ulcerative colitis, 27.1% (29/107) of patients with inactive Crohn's disease (CD), and 5.3% (23/438) of healthy control subjects. The QOL level was significantly lower and anxiety score was significantly higher in inactive CD patients with IBS-like symptoms than in those without such symptoms (P = 0.003, P = 0.009). Use of anti-anxiety drugs was associated with the presence of IBS symptoms (P = 0.045). HR-QOL score was lower and anxiety score was higher in patients with inactive ulcerative colitis, but the difference was not statistically significant. ConclusionsThe prevalence of IBS-like symptoms in inactive IBD patients was significantly higher than in healthy controls. Inactive CD patients with IBS-like symptoms has low QOL and anxiety; suggesting that anxiety may be associated with symptom development in such patients.

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Section: Introductionmentioning

confidence: 99%

Prevalence of Irritable Bowel Syndrome-like Symptoms in Japanese Patients with Inactive Inflammatory Bowel Disease

Tomita

Kato

Takimoto

et al. 2016

J Neurogastroenterol Motil

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“…Both CDEIS and SES-CD are validated scoring systems for CD. Surprisingly, we found that only one-fifth use the CDEIS, and 9.6% the SES-CD, while the CDEIS is known as time consuming and complex [19,20,48].…”

Section: Discussionmentioning

confidence: 88%

“…There are a number of endoscopic disease activity scores that assist endoscopists, but few have been properly evaluated and validated in large cohorts. Good examples are the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) for ulcerative colitis (UC) [16,17], the Crohn's Disease Endoscopic Index of Severity (CDEIS) and the Simple Endoscopic Score (SES-CD) for Crohn's disease (CD) [18][19][20]. Practical and commonly used definitions for MH such as "the complete resolution of the visible alteration or lesions" [21], or endoscopic Mayo score ≤ 1 [22] have the disadvantage of higher interobserver variability and limited accuracy [9,23,24].…”

Section: Introductionmentioning

confidence: 99%

Treatment Targets in Inflammatory Bowel Disease: Current Status in Daily Practice

Römkens

Gijsbers

Kievit³

et al. 2016

JGLD

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Background & Aims: Recently, treatment goals in inflammatory bowel disease (IBD) in clinical trials have shifted from mainly symptom-based to more mucosa-driven. Real world data on treatment priorities are lacking. We aimed to investigate the current practice and most commonly used definitions of IBD treatment targets among Dutch gastroenterologists. Methods: Dutch gastroenterologists were asked to participate in a computer-based nation-wide survey. We asked questions on demographics, opinion and current practice regarding IBD treatment targets. Results: Twenty-four percent (134/556) of the respondents completed the survey. For both Crohn’s disease (CD) (47.3%, 61/129) and ulcerative colitis (UC)(45%, 58/129) the main treatment goal was to achieve and maintain deep remission, defined as clinical, biochemical and endoscopic remission. Seventy-six percent of the participants use mucosal healing (MH) as a potential treatment target for IBD, whereas 22.6% use histological remission. There is no single definition for MH in IBD. The majority use Mayo score ≤ 1 in UC (52%) and ‘macroscopic normal mucosa’ in CD (66%). Conclusion: More stringent and mucosa-driven treatment targets as ‘deep remission’ and ‘mucosal healing’ have found traction in clinical practice. The most commonly used definition for MH in routine practice is endoscopic MAYO score ≤ 1 in UC and ‘macroscopic normal mucosa’ in CD. Abbreviations: CD: Crohn’s disease; CDEIS: Crohn‘s Disease Endoscopic Index of Severity; IBD: Inflammatory Bowel Disease; IBDU: IBD unclassified; IOIBD: International Organization for the Study of Inflammatory Bowel Diseases; MH: Mucosal healing; MMH: Microscopic mucosal healing; PROMS: Patient reported outcome measures; SES-CD: Simple endoscopic score for Crohn’s disease; UC: ulcerative colitis; UCEIS: Ulcerative Colitis Endoscopic Index of Severity.

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“…11 Although symptom-based metrics such as resolution of pain, bleeding, and diarrhea hypothetically might be adequate surrogates for MH, a strong correlation has not been demonstrated between these methods of assessment. 5,6,12,13 A key feature of IBD is the repetitive nature in which epithelial damage occurs, often before clinical signs manifest. 14,15 Thus, the chronicity of damage often is well-established at the time of presentation, and healing often lags behind symptomatic improvement.…”

Section: Mh: Clinical Relevance and Current Definitionsmentioning

confidence: 99%

Assessment of mucosal healing in inflammatory bowel disease: review

Dulai¹,

Levesque²,

Feagan³

et al. 2015

Gastrointestinal Endoscopy

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A Systematic Review of Measurement of Endoscopic Disease Activity and Mucosal Healing in Crohnʼs Disease

Cited by 63 publications

References 93 publications

Prevalence of Irritable Bowel Syndrome-like Symptoms in Japanese Patients with Inactive Inflammatory Bowel Disease

Prevalence of Irritable Bowel Syndrome-like Symptoms in Japanese Patients with Inactive Inflammatory Bowel Disease

Treatment Targets in Inflammatory Bowel Disease: Current Status in Daily Practice

Assessment of mucosal healing in inflammatory bowel disease: review

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