scholarly journals P245 Inter-rater reliability of gastrointestinal ultrasound in the assessment of disease activity in patients with inflammatory bowel disease prior to commencing medical therapy

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S269-S271
Author(s):  
R Smith ◽  
K Taylor ◽  
A Friedman ◽  
H Su ◽  
D Con ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Disease Activity ◽  
Bowel Disease ◽  
Bowel Wall ◽  
Rater Agreement ◽  
Colour Doppler ◽  
Rater Reliability ◽  
Gastrointestinal Ultrasound ◽  
Inflammatory Bowel ◽  
Assessment Of Disease Activity

Abstract Background Gastrointestinal ultrasound (GIUS) is an emerging modality in Australia for the assessment of disease activity in patients with inflammatory bowel disease (IBD). Its utility relies upon reproducibility of key indices, particularly when performed by different operators. Methods The aim of this article was to address the inter-rater reliability among GIUS-credentialed gastroenterologists in Australia, in their assessment of GIUS indices reflecting disease activity in patients with IBD. Methods Patients with IBD were prospectively recruited for paired, consecutive, blinded GIUS assessment at the commencement of a new medical therapy. GIUS was performed by two of four gastroenterologists accredited in GIUS at our centre. GIUS assessment was completed of the known disease distribution. Bowel wall thickness (BWT) was determined from a mean of four measurements for each segment of bowel examined. Colonic and small bowel BWT was defined as normal <3 mm, mild disease 3.1–6 mm, moderate disease 6.1–9 mm and severe disease >9.1 mm. Anastomotic BWT measures were considered as normal <5 mm or abnormal >5.1 mm. Colour Doppler assessment of the bowel wall was based on the Limberg scale1: no colour Doppler signal, mild, moderate and severe. The presence or absence of mesenteric hyperechogenicity surrounding each bowel segment and the presence or absence of reactive lymphadenopathy was assessed. The inter-rater reliability was tested with the Fleiss kappa. Results 26 patients were assessed. Sixty-nine per cent had a diagnosis of Crohn’s disease, 19% with ulcerative colitis and 12% with IBD unclassified. A total of 80 bowel segments were assessed. In the assessment of BWT, the observed agreement was 77.5% and the inter-rater reliability was in the substantial range with a Fleiss’ kappa of 0.63 (95% CI 0.48–0.78, p < 0.001). Of note, the percentage of BWT measures that differed by <1 mm, between each operator, was 79%. When assessing the degree of Doppler activity, the observed agreement was 82.5% and again inter-rater reliability in the substantial range with a Fleiss’ kappa of 0.68 (95% CI 0.54–0.83, p < 0.001). The assessment of mesenteric hyperechogenicity showed an observed agreement of 96.3%, with a near-perfect inter-rater agreement with a Fleiss’ kappa of 0.89 (95% CI 0.76–0.99, p < 0.001). For the presence or absence of lymphadenopathy, the observed agreement between users was 84.6% with a substantial inter-rater agreement reflected by a Fleiss’ kappa of 0.64 (95% CI 0.29–0.98, p < 0.001). Conclusion Among Gastroenterologists experienced and credentialed in GIUS, the inter-rater reliability of markers of intestinal inflammation was substantial, providing confidence in the reproducibility of findings between different operators.

scholarly journals P190 Systematic review: Gastrointestinal ultrasound scoring indices for inflammatory bowel disease

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S233-S233
Author(s):  
T Goodsall ◽  
T Nguyen ◽  
C Ma ◽  
V Jairath ◽  
R Bryant
Keyword(s):  
Inflammatory Bowel Disease ◽  
Disease Activity ◽  
Bowel Disease ◽  
Bowel Wall ◽  
Observer Agreement ◽  
Current Evidence ◽  
Reference Standard ◽  
Disease Phenotype ◽  
Gastrointestinal Ultrasound ◽  
Inflammatory Bowel

Abstract Background The management of inflammatory bowel disease (IBD) requires frequent monitoring and assessment of disease activity. Endoscopic assessment with biopsy remains the gold standard for disease activity. Gastrointestinal ultrasound (GIUS) is a non-invasive, accessible and affordable test used to assess and monitor IBD and has been shown to be similar to MRI for detecting disease. The aim of this study was to systematically review the literature to identify scoring indices used for GIUS measurement of disease activity in IBD and to appraise their operating characteristics. Methods A systematic search of Embase, Medline, Pubmed, Cochrane Central and Clinical Trials.gov from inception to July 2019 was conducted according to PRISMA guidelines. Included were all study types reporting GIUS indices used for grading activity of severity of IBD in comparison to an objective reference standard. Studies using an exclusive clinical reference standard were excluded. All study types and abstracts were considered. Study quality was assessed using the QUADAS tool. Results 27 eligible studies were identified investigating 1647 patients. Disease phenotype was Crohn’s disease (CD) (n = 13), ulcerative colitis (UC) (n = 10) and IBD (n = 4). The most common reference standard was colonoscopy (n = 23), histology (n = 2), and imaging (n = 2). Bowel wall thickness was an index parameter in 26 studies. The most frequent cut off was 3mm (n = 10), 4mm (n = 9), 5mm (n = 1), and not specified (n = 6). There was no noticeable difference in magnitude of cut off when stratified by disease phenotype. Colour Doppler was an index parameter in 16 studies and was based on the Limburg score (n = 7), binary (n = 7) or categorical (n = 2). Bowel wall stratification was an index parameter in 15 studies and was more frequently used in UC (70%) and IBD (75%) indices than in CD indices (38%). Other index parameters included bowel wall compressibility, presence of complications such as abscess or fistula, bowel wall echogenicity, mesenteric inflammatory, lymphadenopathy, contrast enhancement, ulceration, peristalsis, strictures, absence of haustra coli, and tissue sonoelastography. Twenty-three studies were identified as at risk of bias. Overall concordance was substantial to excellent and accuracy was good to excellent. Two studies demonstrated substantial inter-observer agreement. No studies reported intra-observer agreement. Conclusion The identified GIUS scoring indices demonstrate applicability to both CD and UC with good accuracy and concordance. Current evidence does not adequately address concerns about the intra- and inter-observer variability of GIUS. There is a need for robust validation of an evidence-based GIUS index before more widespread use in IBD as a surrogate for colonoscopy and in clinical trials.

scholarly journals P430 Feasibility and reliability of gastrointestinal ultrasound in pregnant inflammatory bowel disease patients

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S391-S393
Author(s):  
F de Voogd ◽  
H Joshi ◽  
E Van Wassenaer ◽  
G D’Haens ◽  
K Gecse
Keyword(s):  
Inflammatory Bowel Disease ◽  
Disease Activity ◽  
Terminal Ileum ◽  
Bowel Disease ◽  
Activity Index ◽  
Third Trimester ◽  
Faecal Calprotectin ◽  
Gastrointestinal Ultrasound ◽  
Inflammatory Bowel ◽  
Active Disease

Abstract Background Disease activity during pregnancy in women with inflammatory bowel disease (IBD) is associated with miscarriage, preterm delivery and low birth weight. Monitoring disease activity throughout the pregnancy is therefore important. Gastrointestinal ultrasound (GIUS) has a high potential as a point-of-care tool for monitoring disease activity in IBD as it has been shown to correlate well with endoscopy and magnetic resonance imaging. However, data are scarce on the use of GIUS in IBD throughout pregnancy. The aim of this prospective study is to determine the feasibility and reliability of GIUS in pregnant IBD patients. Methods Patients were included when visiting the outpatient IBD pregnancy clinic. At each trimester, clinical and biochemical disease activity was evaluated and GIUS was performed. Feasibility was assessed by the ability to visualise each bowel segment (terminal ileum (TI), ascending (AC), transverse (TC), descending (DC) and sigmoid colon (SC)). Reliability was evaluated by using clinical and biochemical disease activity as a gold standard. This was defined as a Harvey–Bradshaw Index ≥4 in Crohn’s disease (CD) or a Simple Clinical Colitis Activity Index ≥5 in ulcerative colitis and a faecal calprotectin (FCP)³ 250 mg/g. Bowel wall thickness (BWT) of > 3 mm in the colon and > 2mm in the terminal ileum was considered as signs of active inflammation on ultrasound. A Mann–Whitney U-test and chi-square were used for statistical analysis. Results Thirty-two IBD patients (54% CD) were studied. Both a GIUS and FCP was available in 18, 11 and 6 patients for the first, second and third trimester, respectively. Eleven of 32 (34%) patients had clinically active disease at least at one time point during the pregnancy. Table 1 shows the visibility per segment. When the active disease was defined as an FCP ≥ 250 mg/g, GIUS could distinguish active from the non-active disease in the first, second and third trimester with a sensitivity of 80%, 75% and 75% and specificity of 85%, 86% and 100%, respectively. FCP levels were significantly higher in patients with an active disease on GIUS regardless of the trimester (mean 1095.5 ± 1453.8 mg/g vs. 265.25 ± 649.8 mg/g, p < 0.0001). Conclusion GIUS is accurate to distinguish active from the quiescent disease in pregnancy. Feasibility to visualise the TI and the SC decreased during the second and third trimester, although active disease could still be detected. Consequently, GIUS is feasible and reliable to assess disease activity throughout pregnancy in IBD.

Monitoring Inflammatory Bowel Disease in Pregnancy Using Gastrointestinal Ultrasonography

2020 ◽  
Vol 14 (10) ◽  
pp. 1405-1412 ◽  
Author(s):  
Emma Flanagan ◽  
Emily K Wright ◽  
Jakob Begun ◽  
Robert V Bryant ◽  
Yoon-Kyo An ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Disease Activity ◽  
Wall Thickness ◽  
Terminal Ileum ◽  
Bowel Disease ◽  
Bowel Wall ◽  
Faecal Calprotectin ◽  
Bowel Wall Thickness ◽  
Inflammatory Bowel ◽  
In Pregnancy

Abstract Background and Aims Inflammatory bowel disease [IBD] affects women during their childbearing years. Gastrointestinal ultrasonography [GIUS] accurately identifies disease activity in non-pregnant patients with IBD. The utility of GIUS in pregnancy has not been established. We aimed to determine the feasibility and accuracy of GIUS in the assessment of IBD during pregnancy progression. Methods A multicentre observational study of women with IBD undergoing GIUS during pregnancy. Clinicians assessed the adequacy of bowel views and disease activity in four colonic segments and the terminal ileum. Location[s] in which views were impeded by the uterus were documented. GIUS disease activity [bowel wall thickness >3 mm] was compared with biochemical disease activity [faecal calprotectin >100 μg/g]. Results Ninety patients and 127 GIUS examinations were included [median gestation 19 weeks, range 4–33]. Adequate colonic views were obtained in 116/127 [91%] scans. Adequate ileal views were obtained in 62/67 [93%] scans <20 weeks and 30/51 [59%] scans at 20–26 weeks. There was a positive correlation between bowel wall thickness and calprotectin [r = 0.26, p = 0.03]. GIUS delivered a specificity of 83%, sensitivity of 74%, and negative predictive value of 90% compared with calprotectin. Conclusions GIUS is a feasible and accurate modality for monitoring IBD in pregnancy. Adequate GIUS views of the colon and terminal ileum can be obtained in the majority of patients up to 20 weeks of gestation. Beyond 20 weeks, GIUS provides good views of the colon but the terminal ileum becomes difficult to assess.

scholarly journals Assessment of disease activity in inflammatory bowel disease: a new approach using 111In granulocyte scanning.

BMJ ◽  
1983 ◽  
Vol 287 (6407) ◽  
pp. 1751-1753 ◽  
Author(s):  
S H Saverymuttu ◽  
J P Lavender ◽  
H J Hodgson ◽  
V S Chadwick
Keyword(s):  
Inflammatory Bowel Disease ◽  
Disease Activity ◽  
Bowel Disease ◽  
New Approach ◽  
Inflammatory Bowel ◽  
Assessment Of Disease Activity
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