Validation of the ‘Inflammatory Bowel Disease—Distribution, Chronicity, Activity [IBD-DCA] Score’ for Ulcerative Colitis and Crohn´s Disease

Lang-Schwarz, Corinna; Angeloni, Miriam; Agaimy, Abbas; Atreya, Raja; Becker, Christoph; Dregelies, Theresa; Danese, Silvio; Fléjou, Jean‐François; Gaßler, Nikolaus; Grabsch, Heike; Hartmann, Arndt; Kamarádová, Kateřina; Kühl, Anja A.; Lauwers, Gregory Y.; Lugli, Alessandro; Nagtegaal, Irıs D.; Oberhuber, Georg; Peyrin–Biroulet, Laurent; Räth, Timo; Riddell, Robert H.; Rubio, Carlos A.; Sheahan, Kieran; Siegmund, Britta; Tilg, Herbert; Villanacci, Vincenzo; Westerhoff, Maria; Ferrazzi, Fulvia

doi:10.1093/ecco-jcc/jjab055

Cited by 24 publications

(19 citation statements)

References 49 publications

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“…▶ Fig. 3 Endoscopic images of potentially premalignant lesions in the colon and colorectal cancer showing: a, b a non-advanced tubular ade- The studies that are available have assessed, usually in retrospect, the correlation between endoscopic activity and histology [59][60][61][62][63][64][65][66][67]. The Simple Endoscopic Score for Crohn's disease (SES-CD) is the most commonly used endoscopic score.…”

Section: Recommendationmentioning

confidence: 99%

Endoscopic tissue sampling – Part 2: Lower gastrointestinal tract. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2021

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Recommendations 1 ESGE suggests performing segmental biopsies (at least two from each segment), which should be placed in different specimen containers (ileum, cecum, ascending, transverse, descending, and sigmoid colon, and rectum) in patients with clinical and endoscopic signs of colitis.Weak recommendation, low quality of evidence. 2 ESGE recommends taking two biopsies from the right hemicolon (ascending and transverse colon) and, in a separate container, two biopsies from the left hemicolon (descending and sigmoid colon) when microscopic colitis is suspected.Strong recommendation, low quality of evidence. 3 ESGE recommends pancolonic dye-based chromoendoscopy or virtual chromoendoscopy with targeted biopsies of any visible lesions during surveillance endoscopy in patients with inflammatory bowel disease. Strong recommendation, moderate quality of evidence. 4 ESGE suggests that, in high risk patients with a history of colonic neoplasia, tubular-appearing colon, strictures, ongoing therapy-refractory inflammation, or primary sclerosing cholangitis, chromoendoscopy with targeted biopsies can be combined with four-quadrant non-targeted biopsies every 10 cm along the colon. Weak recommendation, low quality of evidence. 5 ESGE recommends that, if pouch surveillance for dysplasia is performed, visible abnormalities should be biopsied, with at least two biopsies systematically taken from each of the afferent ileal loop, the efferent blind loop, the pouch, and the anorectal cuff.Strong recommendation, low quality of evidence. 6 ESGE recommends that, in patients with known ulcerative colitis and endoscopic signs of inflammation, at least two biopsies be obtained from the worst affected areas for the assessment of activity or the presence of cytomegalovirus; for those with no evident endoscopic signs of inflammation, advanced imaging technologies may be useful in identifying areas for targeted biopsies to assess histologic remission if this would have therapeutic consequences. Strong recommendation, low quality of evidence. 7 ESGE suggests not biopsying endoscopically visible inflammation or normal-appearing mucosa to assess disease activity in known Crohn’s disease.Weak recommendation, low quality of evidence. 8 ESGE recommends that adequately assessed colorectal polyps that are judged to be premalignant should be fully excised rather than biopsied.Strong recommendation, low quality of evidence. 9 ESGE recommends that, where endoscopically feasible, potentially malignant colorectal polyps should be excised en bloc rather than being biopsied. If the endoscopist cannot confidently perform en bloc excision at that time, careful representative images (rather than biopsies) should be taken of the potential focus of cancer, and the patient should be rescheduled or referred to an expert center.Strong recommendation, low quality of evidence. 10 ESGE recommends that, in malignant lesions not amenable to endoscopic excision owing to deep invasion, six carefully targeted biopsies should be taken from the potential focus of cancer.Strong recommendation, low quality of evidence.

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Section: Recommendationmentioning

confidence: 99%

Endoscopic tissue sampling – Part 2: Lower gastrointestinal tract. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2021

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“…Such features have been differently combined to build up several histological scoring systems. Although showing slight differences, the main histological features of UC activity are shared with CD, so that the same histological indexes are now being applied in clinical trials, and new ones are being designed to be applied to both diseases [19][20][21]. We briefly summarize the main microscopic features of IBD and the evidence to support their inclusion in histopathologic reports.…”

Section: Assessing Histological Disease Activity: a Guide For The Cli...mentioning

confidence: 99%

“…The need for a score which is simple, reproducible and applicable to both UC and CD led to the development in 2021 of the Inflammatory Bowel Disease-Distribution, Chronic-ity, Activity (IBD-DCA) score [21]. Differently to NI and RHI, which mostly include features of inflammation, chronic and architectural features have been included in the IBD-DCA score.…”

Section: Ibd-dca Scorementioning

confidence: 99%

Histological Scores in Patients with Inflammatory Bowel Diseases: The State of the Art

D’Amico

Sollai

Allocca

et al. 2022

JCM

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The histological assessment has been advocated as a detailed and accurate measure of disease activity in inflammatory bowel diseases (IBD). In ulcerative colitis (UC), histological activity has been demonstrated to be associated with higher rates of relapse, prolonged corticosteroid use and long-term complications, even when endoscopic remission is achieved. Therefore, histological healing may represent a potential treatment target. Several histological scores have been developed and are available today. The Robarts histopathology index (RHI) and the Nancy index (NI) are the only two recommended by the European Crohn’s and Colitis Organization (ECCO) for use in patients with UC. Conversely, in Crohn’s disease (CD), the discontinuous nature of lesions has limited standardized histological assessment. Most of the available histological scoring systems in CD are complex and not validated. The aim of this review is to comprehensively summarize the latest evidence regarding histological scoring systems in IBD. We guide the reader through understanding the importance of an accurate microscopic evaluation using validated scoring systems, highlighting the strengths and pitfalls of each score. The priorities of future research needs are also addressed.

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“…Clinical judgment and the histological evaluation of endoscopic biopsies are sine qua non , in the diagnosis and follow‐up of patients with IBD 6 . The narrative of pathological reports in IBD usually contains, besides increased number of inflammatory cells (empirically subdivided into slight, moderate, or marked), crypts with architectural distortions, a concept that includes colon crypts varying in size and shape, separated by unequal amounts of lamina propria , and branching crypts 7 …”

Section: Introductionmentioning

confidence: 99%

Branching crypts in inflammatory bowel disease revisited

Rubio

Schmidt

Lang-Schwarz

2021

J of Gastro and Hepatol

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Histologic sections from patients with inflammatory bowel disease (IBD) usually exhibit crypts with architectural distortions and branching crypts. It has been postulated that crypt branching should be assessed only in well‐oriented, upright crypts. However, those crypts are mostly found in sections from colectomy specimens and colon mucosectomies. Sections from endoscopic biopsies are fortuitously cut in a horizontal plane, a procedure mostly revealing cross‐cut crypt rings. In endoscopic biopsies from UC patients we previously detected cross‐cut crypts heralding the crest domain of branching crypts. Recently, the scrutiny of biopsies from IBD patients revealed that branching‐crest domains concurred either with crypts in symmetric branching, typified by twin, amalgamating back‐to‐back isometrics crypt‐rings, or with crypts in asymmetric branching, characterized by ≥2 amalgamating anisometric crypt‐rings; both symmetric and asymmetric branching‐crest domains were encased by a thin muscularis mucosae. Quantitative studies in biopsies from Swedish and German patients with IBD showed that crypts in asymmetric branching outnumbered those in symmetric branching. Because crypt‐branching seldom occurs in the normal colon in adults and considering that colon crypts typically divide once or twice during a lifetime, the accruing of asymmetric branching crypts in IBD biopsies emerges as a significant histologic parameter. Although the biological significance of asymmetric crypt‐branching in IBD remains at present elusive, their occurrence deserves to be further investigated. The future policy will be to include in our pathologic reports, the number of crypts in asymmetric branching, in order to monitor their frequency in prospective surveillance biopsies in patients with IBD.

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Validation of the ‘Inflammatory Bowel Disease—Distribution, Chronicity, Activity [IBD-DCA] Score’ for Ulcerative Colitis and Crohn´s Disease

Cited by 24 publications

References 49 publications

Endoscopic tissue sampling – Part 2: Lower gastrointestinal tract. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Endoscopic tissue sampling – Part 2: Lower gastrointestinal tract. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Histological Scores in Patients with Inflammatory Bowel Diseases: The State of the Art

Branching crypts in inflammatory bowel disease revisited

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