Proposal of a new clinical index predictive of endoscopic severity in ulcerative colitis

Azzolini, Francesco; Rigo, Gianpiero; Camellini, L.; Scarcelli, A.; Merighi, A.; Primerano, A.M.; Pagnini, Cristiano; Bertani, A.; Antonioli, A.; Manenti, F.

doi:10.1016/s1590-8658(01)80198-5

Cited by 3 publications

(5 citation statements)

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“…Patient-reported outcomes 2: rectal bleeding and stool frequency. Overall, 4 studies provided information on PRO2 and other clinical indices (Lewis et al, 19 Dhanda et al, 20 Azzolini et al, 12 and Seo et al 3 ) and all showed that the PRO2 correlation with endoscopic disease activity was stronger or at least comparable with established clinical indices with a Spearman correlation coefficient varying from 0.64 to 0.89 (P < .01). Two post hoc analyses of clinical trials (Jharap et al, 21 Jairath et al 1 ) and 1 prospective cohort study (Colombel et al 22 ) compared PRO2 independently of composite clinical indices with endoscopic assessment.…”

Section: Association Between Clinical Symptoms and Endoscopy In The Dmentioning

confidence: 97%

“…Active vs inactive disease. Overall, 8 studies only included patients with active disease (Lewis et al, 19 Dhanda et al, 20 Jharap et al, 21 Scaioli et al, 23 Seo et al, 3 Achitei et al, 24 Mirpour et al, 25 Jairath et al 1 ), whereas 15 studies included patients with both active and inactive disease (Bodelier et al, 26 Schoepfer et al, 27 Pagnini et al, 28 Beattie et al, 7 Azzolini et al, 12 Hirai et al, 29 Langhorst et al, 30 Arai et al, 31 Higging et al, 32 Ricanek et al, 33 Samuel et al, 34 Taleban et al, 35 Falvey et al, 36 Chen et al, 37 and Colombel et al 22 ). Unfortunately, the published data do not provide information for active vs inactive disease separately.…”

Section: Association Between Clinical Symptoms and Endoscopy In The Dmentioning

confidence: 99%

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Clinical Parameters Correlate With Endoscopic Activity of Ulcerative Colitis: A Systematic Review

Restellini

Chen

Martel

et al. 2019

Clinical Gastroenterology and Hepatology

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BACKGROUND & AIMS: Optimal management of patients with ulcerative colitis (UC) requires assessment of disease activity-usually by endoscopy, which is invasive, costly, and not risk free. We performed a systematic review to determine whether clinical symptoms correlate with findings from endoscopy assessments of patients with UC. METHODS: We performed a systematic review of publication databases from January 1980 through July 2018 to identify clinical trials and observational studies reporting correlations among symptoms, disease activity index scores and/or patient reported outcomes (rectal bleeding and/or stool frequency), and endoscopic disease activity. Correlations were ascertained in patients with active vs inactive disease and by disease extent and treatment type. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Because of significant heterogeneity, meta-analysis was not possible. Results were synthesized qualitatively and systematically. RESULTS: Our final analysis included 23 studies (1 randomized trial, 22 observational studies) comprising 3320 patients with UC. The studies used a variety of measures to assess clinical activity, endoscopic activity, and measures of correlation (sensitivity, specificity, correlation coefficients, area under the receiver operator curve). Overall, studies were at moderate-high risk of bias. Composite clinical measures, including rectal bleeding and stool frequency, had moderate to strong correlations with endoscopic disease activity; the absence of rectal bleeding identified patients with inactive disease with higher levels of sensitivity than normalization of stool frequency. In general, symptoms correlated more strongly with endoscopic activity in patients with left-sided colitis than extensive colitis. The effect of different medications on the correlation between clinical and endoscopic activity has not been well studied. CONCLUSIONS: In a systematic review, we found a moderate to strong correlation between clinical activity, particularly the combination of rectal bleeding and stool frequency, and endoscopic activity in patients with UC. Although these clinical assessments could help prioritize patients for endoscopic evaluation in resource-limited settings, challenges associated with treating patients based on symptoms alone preclude adaptation of current management algorithms.

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Section: Association Between Clinical Symptoms and Endoscopy In The Dmentioning

confidence: 97%

Section: Association Between Clinical Symptoms and Endoscopy In The Dmentioning

confidence: 99%

Clinical Parameters Correlate With Endoscopic Activity of Ulcerative Colitis: A Systematic Review

Restellini

Chen

Martel

et al. 2019

Clinical Gastroenterology and Hepatology

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“…Clinical remission and clinical response have often been defined based on a previously used index. However, in some clinical trials, an evaluation of disease activity has been made based on a proposed new activity index 15,16 . Thus, the existence of numerous indices to determine the activity of UC has prevented the establishment of a standard index for use in clinical trials.…”

Section: Discussionmentioning

confidence: 99%

“…The Baron score, a four‐point scale based mainly on the severity of bleeding, was first described in 1964 8 . As an evaluation of bleeding is possible only by the physician who carries out each endoscopy, there are now currently many modified Baron scores based on various mucosal findings 4,15,16,18–20 . We included the modified Baron score in an analysis of representative EI (Table 2).…”

Section: Discussionmentioning

confidence: 99%

Validity of Activity Indices in Ulcerative Colitis: Comparison of Clinical and Endoscopic Indices

Hirai

Matsui

Aoyagi

et al. 2009

Digestive Endoscopy

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“…Many empirically derived indices have been developed, usually including measures of bowel movement frequency, stool blood and clinical assessment 1–4 . Some indices have added biomarkers in the blood (haemoglobin, albumin or erythrocyte sedimentation rate) 5, 6 or endoscopic assessment 7, 8 . None of these indices has been rigorously validated.…”

Section: Introductionmentioning

confidence: 99%

The quantitative validation of non‐endoscopic disease activity indices in ulcerative colitis

Higgins

Leung

Schwartz

et al. 2007

Aliment Pharmacol Ther

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Summary Background Ulcerative colitis disease activity indices have not been formally validated. Aim To analise quantitatively the psychometric and performance validity of two non‐endoscopic indices for ulcerative colitis, the Simple Clinical Colitis Activity Index and the Seo Index. Methods In 66 patients with ulcerative colitis, the measurement of disease activity was repeated with the two non‐endoscopic indices, St Mark's Index, and the Inflammatory Bowel Disease Questionnaire. Psychometric validity was evaluated by measuring the content, construct, criterion‐convergent and criterion‐predictive validity on a 0–1 scale. Performance validity was evaluated by measuring the reproducibility and responsiveness on a 0–1 scale. Results The Simple Clinical Colitis Activity Index had good to excellent psychometric and performance validity, while the Seo Index had moderate to excellent psychometric validity and moderate to good performance validity. The Simple Clinical Colitis Activity Index had weaknesses in content validity and in responsiveness. The Seo Index had weaknesses in content validity, construct validity and responsiveness. Conclusions These two non‐endoscopic indices for ulcerative colitis have good psychometric and performance validity, and are now the most rigorously validated disease activity indices for ulcerative colitis. The Simple Clinical Colitis Activity Index appears to have better overall validity. Quantitative evaluation identifies weaknesses in disease activity indices, and can lead to better disease activity indices for ulcerative colitis.

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Proposal of a new clinical index predictive of endoscopic severity in ulcerative colitis

Cited by 3 publications

References 0 publications

Clinical Parameters Correlate With Endoscopic Activity of Ulcerative Colitis: A Systematic Review

Clinical Parameters Correlate With Endoscopic Activity of Ulcerative Colitis: A Systematic Review

Validity of Activity Indices in Ulcerative Colitis: Comparison of Clinical and Endoscopic Indices

The quantitative validation of non‐endoscopic disease activity indices in ulcerative colitis

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