Clinical disease activity scores unreliable in pediatric Crohn's disease

Reuters Health Information: Clinical disease activity scores unreliable in pediatric Crohn's disease

Clinical disease activity scores unreliable in pediatric Crohn's disease

Last Updated: 2018-10-11

By Will Boggs MD

NEW YORK (Reuters Health) - Clinical disease activity scores correlate only poorly with endoscopic severity in children with newly-diagnosed Crohn's disease (CD), researchers from Canada report.

The Pediatric CD Activity Index (PCDAI) is commonly used to measure clinical disease activity, but how well it reflects endoscopic severity remains unclear.

Dr. Nicholas Carman from Children's Hospital of Eastern Ontario and the University of Ottawa and colleagues in the Canadian Children Inflammatory Bowel Disease Network compared weighted PCDAI (wPCDAI) scores and Simple Endoscopic Score for Crohn's Disease (SES-CD) scores in 280 children and adolescents with newly-diagnosed CD.

Based on wPCDAI scores, 52% of patients had severely active disease at diagnosis, with relatively similar scores in those with ileal, colonic, or ileocolonic involvement, according to the September 28th Gastrointestinal Endoscopy online report.

Median SES-CD scores reflected moderate ileal disease, severe colonic disease, and severe ileocolonic disease.

There was only a weak correlation between SES-CD and wPCDAI scores (r=0.39), and the correlation was weaker in patients with clinically less active disease (r=0.08 with none/mild disease; r=0.33 with moderate/severe disease).

There was a moderate correlation between the two scores in patients with isolated colonic disease (r=0.49), but a weaker correlation in patients with ileocolonic disease (r=0.36) and no relationship in isolated ileal disease (r=0.05).

"This study demonstrates that currently available composite clinical disease activity scores and commonly used blood tests correlate poorly with endoscopic assessment, and therefore should not be used in isolation to assess global disease activity," the researchers conclude. "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. This should, however, be combined with objective mucosal assessment to monitor treatment outcomes, both in clinic and in the context of clinical trials."

Dr. David T. Rubin from the University of Chicago, who has researched various aspects of adult and pediatric CD, told Reuters Health by email, "The message that is key is that reliance on serologic markers (lab tests) or symptoms is insufficient in the management of CD. Importantly as well, pediatricians should not base their suspicion of the diagnosis of CD on symptoms or labs alone. As has been described before, a clinician needs to suspect Crohn's disease when a child is not developing or 'falls off' their growth curve. The absence of GI symptoms is insufficient to rule out bowel inflammation!"

"There is inertia for good reason to scope children due to the need for preparation, anesthesia, and exposure to an invasive procedure, as well as the psychological effects of having GI procedures," he said. "Therefore, given these findings and the importance of treating patients for disease control and improved outcomes, it is critically important that we develop appropriate surrogates that do correlate to endoscopic findings."

"An individualized approach per child may be best - some kids will have better correlates than others, and knowing which ones don't have a marker that aligns with the endoscopic findings will allow stratification to utilize endoscopic follow-up in them," Dr. Rubin said.

Dr. Carman did not respond to a request for comments.


GI Endoscopy 2018.

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