Original article
Alimentary tract
Validation of the Ulcerative Colitis Colonoscopic Index of Severity and Its Correlation With Disease Activity Measures

https://doi.org/10.1016/j.cgh.2012.08.003Get rights and content

Background & Aims

Endoscopic healing is likely to become an important goal for treatment of patients with ulcerative colitis (UC). A simple validated endoscopic index is needed. We validated the previously developed UC Colonoscopic Index of Severity (UCCIS).

Methods

In a prospective study, 50 patients with UC were examined by colonoscopy; we analyzed videos of rectum and sigmoid, descending, transverse, and cecum/ascending colon. Eight gastroenterologists blindly rated 4 mucosal lesions (for vascular pattern, granularity, friability, ulceration) and severity of damage to each segment and overall. The global assessment of endoscopic severity (GAES) was based on a 4-point scale and 10-cm visual analogue scale. Correlation of the UCCIS score with clinical indexes (clinical activity index and simple clinical colitis activity index), patient-defined remission, and laboratory measures of disease activity (levels of C-reactive protein, albumin, and hemoglobin and platelet counts) were estimated by using the Pearson (r) or Spearman (rs) method.

Results

Interobserver agreement was good to excellent for the 4 mucosal lesions evaluated by endoscopy and the GAES. The UCCIS calculated for our data accounted for 74% (R2 = 0.74) and 80% (R2 = 0.80) of the variation in the GAES and visual analogue scores, respectively (P < .0001). The UCCIS also correlated with clinical activity index (r = 0.52, P < .001), simple clinical colitis activity index (r = 0.62, P < .0001), and patient-defined remission (r = 0.43, P < .01). The UCCIS also correlated with levels of C-reactive protein (rs = 0.56, P < .001), albumin (r = –0.55, P < .001), and hemoglobin (r = –0.39, P < .01). A rederivation of the equation for the UCCIS by using the data from a previous study combined with those of the current study (n = 101) yielded similar results.

Conclusions

The UCCIS is a simple tool that provides reproducible results in endoscopic scoring of patients with UC.

Section snippets

Patients and Examination

Patients with UC and a spectrum of disease severity were prospectively recruited to this study, and written informed consent was obtained from all participants before inclusion. The study was approved by the Mayo Clinic Institutional Review Board. The patients included in the study had an established diagnosis of UC for ≥3 months and underwent colonoscopic assessment of their disease between December 2009 and June 2010. Those patients with prior colon surgery, indeterminate colitis, Crohn's

Patient Demographics and Video Clip Assessment

We recruited 53 patients to the study. Three patients were excluded because of poor bowel preparation or failed acquisition of digital video files. The remaining 50 patients had complete video recording of their colonoscopic assessment, and Table 2 shows their demographics and clinical information. The median age of the study patients was 46.5 years, and nearly half were men (48%). The most common indication for colonoscopy in our cohort was for assessment of activity of UC in 23 (46%),

Discussion

Mucosal healing has become an important measure of treatment efficacy in UC clinical trials, and hence there is an urgent need for a simple, reproducible, and validated scoring index of severity in UC. We found good IOA (reproducibility) among a group of experienced gastroenterologists for granularity, vascular pattern, bleeding/friability, and ulcerations. A composite score that used these 4 mucosal variables significantly accounted for the variations in the GAES. We validated the UCCIS score,

Acknowledgments

Presented in part at the Annual Meeting of the American Gastroenterological Association (DDW 2011), Chicago, Illinois, May 8–10, 2011.

References (25)

  • S.A. Riley et al.

    Microscopic activity in ulcerative colitis: what does it mean?

    Gut

    (1991)
  • P. Rutgeerts et al.

    Mucosal healing in inflammatory bowel disease: impossible ideal or therapeutic target?

    Gut

    (2007)
  • Cited by (0)

    Conflicts of interest The authors disclose no conflicts.

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