Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2017; 23(18): 3322-3329
Published online May 14, 2017. doi: 10.3748/wjg.v23.i18.3322
Correlation of endoscopic disease severity with pediatric ulcerative colitis activity index score in children and young adults with ulcerative colitis
Basavaraj Kerur, Heather J Litman, Julia Bender Stern, Sarah Weber, Jenifer R Lightdale, Paul A Rufo, Athos Bousvaros
Basavaraj Kerur, Pediatric Gastroenterology, Hasbro Children’s Hospital, Providence, RI 02903, United States
Heather J Litman, Corrona, LLC Southborough, MA 01772, United States
Julia Bender Stern, Sarah Weber, Paul A Rufo, Athos Bousvaros, Inflammatory Bowel Disease Center, Children’s Hospital Boston, MA 02115, United States
Jenifer R Lightdale, Division of Pediatric Gastroenterology, UMass Memorial Medical Center, University Campus Worcester, MA 01655, United States
Author contributions: Kerur B designed the study, extracted clinical information, manuscript writing; Litman HJ statistical analysis; Stern JB data collection/chart review/SPSS database maintenance; Weber S data collection/chart review/SPSS database maintenance; Lightdale JR review of endoscopic disease activity; Rufo PA review of endoscopic disease activityAnalysis of endoscopic score; Bousvaros A designed the study, reviewed charts and endoscopic disease activity, manuscript writing, project supervisor.
Institutional review board statement: Approved by IRB Boston Childrens Hospital.
Informed consent statement: Retrospective review of clinical charts, waiver of consent was obtained from IRB.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Basavaraj Kerur, MD, Pediatric Gastroenterology, Hasbro Children’s Hospital, Providence, MPH 134, 593 Eddy St, RI 02903, United States. kerurbas@gmail.com
Telephone: +1-401-4448306 Fax: +1-401-4448748
Received: October 26, 2016
Peer-review started: October 28, 2016
First decision: December 19, 2016
Revised: January 10, 2017
Accepted: April 12, 2017
Article in press: April 12, 2017
Published online: May 14, 2017
Processing time: 200 Days and 7.8 Hours
Abstract
AIM

To investigate of pediatric ulcerative colitis activity index (PUCAI) in ulcerative colitis correlate with mucosal inflammation and endoscopic assessment of disease activity (Mayo endoscopic score).

METHODS

We reviewed charts from ulcerative colitis patients who had undergone both colonoscopy over 3 years. Clinical assessment of disease severity within 35 d (either before or after) the colonoscopy were included. Patients were excluded if they had significant therapeutic interventions (such as the start of corticosteroids or immunosuppressive agents) between the colonoscopy and the clinical assessment. Mayo endoscopic score of the rectum and sigmoid were done by two gastroenterologists. Inter-observer variability in Mayo score was assessed.

RESULTS

We identified 99 patients (53% female, 74% pancolitis) that met inclusion criteria. The indications for colonoscopy included ongoing disease activity (62%), consideration of medication change (10%), assessment of medication efficacy (14%), and cancer screening (14%). Based on PUCAI scores, 33% of patients were in remission, 39% had mild disease, 23% had moderate disease, and 4% had severe disease. There was “moderate-substantial” agreement between the two reviewers in assessing rectal Mayo scores (kappa = 0.54, 95%CI: 0.41-0.68).

CONCLUSION

Endoscopic disease severity (Mayo score) assessed by reviewing photographs of pediatric colonoscopy has moderate inter-rater reliability, and agreement was less robust in assessing patients with mild disease activity. Endoscopic disease severity generally correlates with clinical disease severity as measured by PUCAI score. However, children with inflamed colons can have significant variation in their reported clinical symptoms. Thus, assessment of both clinical symptoms and endoscopic disease severity may be required in future clinical studies.

Keywords: Ulcerative colitis; Pediatric ulcerative colitis activity index; Mayo score

Core tip: There is controversy regarding what the best method of assessing disease activity in pediatric ulcerative colitis. Currently, the best accepted tool is the pediatric ulcerative colitis activity index (PUCAI), developed by Turner and colleagues, which is a physician reported measure. Because of its formal validation and ease of use, the PUCAI has been widely accepted both as a clinical tool by physicians. Other experts have suggested that biomarkers, patient reported outcomes, or endoscopic disease activity may be better measures. In this study, we show physicians looking at endoscopic photos may grade the Mayo endoscopic scores differently, and that the PUCAI generally correlates well with endoscopic disease activity.