Endoscopic activity in inflammatory bowel disease: clinical significance and application in practice

Abstract

Endoscopy is vital for diagnosing, assessing treatment response, and monitoring surveillance in patients with inflammatory bowel disease (IBD). With the growing importance of mucosal healing as a treatment target, the assessment of disease activity by endoscopy has been accepted as the standard of care for IBD. There are many endoscopic activity indices for facilitating standardized reporting of the gastrointestinal mucosal appearance in IBD, and each index has its strengths and weaknesses. Although most endoscopic indices do not have a clear-cut validated definition, endoscopic remission or mucosal healing is associated with favorable outcomes, such as a decreased risk of relapse. Therefore, experts suggest utilizing endoscopic indices for monitoring disease activity and optimizing treatment to achieve remission. However, the regular monitoring of endoscopic activity is limited in practice owing to several factors, such as the complexity of the procedure, time consumption, inter-observer variability, and lack of a clear-cut, validated definition of endoscopic response or remission. Although experts have recently suggested consensus-based definitions, further studies are needed to define the values that can predict long-term outcomes.

Use of Standardized Inflammatory Bowel Disease Endoscopy Scores in Clinical Practice

“…Given the low rate of use, interventions to raise awareness regarding the importance of consistent use of endoscopic scoring systems in clinical practice are needed as well as programs to provide additional training, possibly through national gastroenterology and IBD societies. Review articles are available which provide an overview of these endoscopic scoring systems and address the need to incorporate IBD endoscopic scoring as part of a treat to target approach to IBD care 9 , 10 ; however, further evaluation to identify specific barriers to use and ways to further improve the utilization of IBD endoscopic scoring is needed.…”

Ocular endothelial dysfunction in pediatric inflammatory bowel disease

“…Additionally, clinical disease activity was assessed using the Pediatric Crohn's Disease Activity Index 26 and the Pediatric Ulcerative Colitis Activity Index (PUCAI) 27 . Endoscopic disease activity was measured using the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and the Simple Endoscopic Score for Crohn's Disease (SES‐CD) 28 …”

“…27 Endoscopic disease activity was measured using the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and the Simple Endoscopic Score for Crohn's Disease (SES-CD). 28 In both groups, auxological parameters (height, weight, and Body Mass Index) and blood pressure values were recorded. Furthermore, all patients underwent blood and fecal tests to assess metabolic profiles (total cholesterol, high-density lipoprotein [HDL] cholesterol, low-density lipoprotein cholesterol, triglycerides, serum glucose, and insulin) and inflammatory status (white blood cell count, red blood cell count, platelet count, hemoglobin, C-reactive protein, erythrocyte sedimentation rate, coagulation profile, serum albumin, ferritin, and fecal calprotectin).…”

Evaluation of Disease Activity in Inflammatory Bowel Disease: Diagnostic Tools in the Assessment of Histological Healing

“…Given the concept that the resolution of intestinal inflammation beyond endoscopic healing could provide clinically relevant advantages or major contributions to patient care, there is increasing interest in assessing histological disease activity. Clinical signs and symptoms combined with endoscopic examination are traditionally used to monitor and assess disease activity status in IBD [11]. HH is achievable in many UC patients and is associated with better disease outcomes than clinical remission and/or endoscopic healing, as revealed by several studies [12].…”