scholarly journals Efficacy of Sigmoidoscopy for Evaluating Disease Activity in Patients With Ulcerative Colitis

2021 ◽  
Author(s):  
Su Bum Park ◽  
Seong-Jung Kim ◽  
Jun Lee ◽  
Yoo Jin Lee ◽  
Dong Hoon Baek ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Disease Activity ◽  
Proximal Colon ◽  
Concordance Rate ◽  
Tertiary Hospitals ◽  
High Concordance ◽  
Endoscopic Score ◽  
Index Of Severity ◽  
Endoscopic Assessment ◽  
Key Parameter

Abstract Background: Endoscopic assessment of disease activity is a key parameter in the management of ulcerative colitis. Whether sigmoidoscopy alone is sufficient to evaluate the disease activity in ulcerative colitis lacks studies. Methods: We retrospectively analyzed the medical records and endoscopic results of patients with ulcerative colitis followed by colonoscopy in seven tertiary hospitals between January 2012 and December 2018. Endoscopic disease activity was scored using the Mayo Endoscopic Score (MES) and Ulcerative Colitis Endoscopic Index of Severity (UCEIS) for each segment from the colonoscopy images. Concordance was evaluated by comparing the highest MES and UCEIS in the rectosigmoid and proximal regions to confirm the usefulness of sigmoidoscopy. Results: A total of 500 colonoscopic examinations from 333 patients were enrolled. Only in 7.6% [k(kappa): 0.893, r(Spearman): 0.906, p<0.001] and 8.6% [k(kappa): 0.890, r(Spearman): 0.914; p<0.001] of cases, MES and UCEIS scored more severely in the proximal colon. Comparison of active disease (MES ≥2) in the rectosigmoid area and the entire colon showed a high concordance rate [k(kappa): 0.899, r(Spearman): 0.904, p<0.001]. Endoscopic healing (MES=0) also showed a high concordance rate [k(kappa): 0.882, r(Spearman): 0.887, p<0.001]. In 38 cases (7.6%) of patients with a higher MES in the proximal area, it was significantly higher in patients with previous extensive colitisConclusions: Sigmoidoscopy and colonoscopy showed a high concordance rate. Therefore, sigmoidoscopy is considered a sufficient substitute for colonoscopy. However, colonoscopy should be considered in patients with previous extensive colitis

scholarly journals P225 Using a standardised reporting proforma is associated with improved endoscopic assessment in UC

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S255-S255
Author(s):  
R KADER ◽  
P Middleton ◽  
O Ahmad ◽  
R Dart ◽  
J McGuire ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Disease Activity ◽  
Site Factors ◽  
Multi Centre Study ◽  
Gi Endoscopy ◽  
Mayo Score ◽  
Chi Squared ◽  
Index Of Severity ◽  
Level Of Training ◽  
Endoscopic Assessment

Abstract Background Repeated endoscopic assessments are an essential part of ulcerative colitis (UC) disease management and current guidelines recommend the use of an endoscopic activity score, either the endoscopic Mayo score or Ulcerative Colitis Endoscopic Index of Severity (UCEIS) as treatment targets. These indices have prognostic value, with endoscopic healing associated with favourable short- and long-term outcomes. This multi-centre study aimed to assess the frequency of using endoscopic disease activity scores in UC patients undergoing lower GI endoscopy. Methods Lower GI endoscopy reports from patients with UC were retrospectively reviewed from 7 sites in London between April and October 2018. Endoscopy reports were assessed based on the BRIDGe endoscopic reporting criteria including the use of Mayo or UCEIS score. The comparison was made between site factors (specialist IBD centres/non-specialist centres, use of reporting proforma), endoscopist speciality (gastroenterology, surgery or nurse endoscopist), level of training (consultant, registrar or nurse endoscopist) and interest in IBD. Chi-squared was used to compare groups. Results 899 lower GI endoscopy reports were reviewed. Mayo or UCEIS was used in 51% of cases (453/899). The use of endoscopic scores were significantly higher in gastroenterologists than in surgeons and nurse endoscopists respectively (401/762 (53%) vs. 22/54 (41%) vs. 30/83 (36%)), and higher in registrar trainees than consultants and nurse endoscopists (175/251 (70%) vs. 248/565 (44%) vs. 30/83 (36%)) and in those with a specialist interest in IBD compared with those without (237/409 (58%) vs. 216/490 (44%), p &lt; 0.0001). The use of endoscopic scores was more frequent in specialist IBD centres than in non-specialist centres (417/728 (58%) vs. 36/172 (21%), p &lt; 0.001). One centre used a reporting proforma which was associated with a significantly higher frequency of score use compared with centres without a proforma (202/260 (78%) vs. 251/639 (39%), p &lt; 0.0001). Conclusion Reporting of endoscopic disease activity using a standardised scoring system occurs in only half of cases from this large multi-centre cohort. Frequency of use is higher in specialist IBD centres and when performed by gastroenterology specialists. Endoscopy reports from a site that used a standardised reporting proforma were significantly more likely to include an endoscopic index as well as a range of other reporting items. This suggests, at least in part, that endoscopy reporting may be optimised by the introduction of a proforma. Integration of a standardised proforma into reporting software would target all endoscopists performing UC endoscopies regardless of speciality, site or IBD interest.

scholarly journals Role of Fecal Calprotectin as a Noninvasive Indicator for Ulcerative Colitis Disease Activity

Folia Medica ◽  
2019 ◽  
Vol 61 (2) ◽  
pp. 188-196 ◽  
Author(s):  
Radislav V. Nakov ◽  
Ventsislav N. Nakov ◽  
Vanya A. Gerova ◽  
Lyudmila T. Tankova
Keyword(s):  
Ulcerative Colitis ◽  
Disease Activity ◽  
Intestinal Inflammation ◽  
Point Of Care ◽  
Fecal Calprotectin ◽  
Non Invasive ◽  
Significant Difference ◽  
Endoscopic Score ◽  
Index Of Severity

Abstract Background: It is essential in clinical management to determine the disease activity in ulcerative colitis (UC) patients. At present, the most accurate way of evaluating the UC severity is endoscopy with biopsy. Fecal calprotectin (FCP) is a non-invasive biomarker that is frequently used for monitoring of intestinal inflammation. Aims: The purpose of our study was to assess the role of FCP as a noninvasive indicator for UC disease activity. Materials and methods: This prospective study enrolled 116 patients with UC (56 with quiescent UC and 60 with active UC) and 36 controls, referred for colonoscopy to our Center. Colonoscopy was performed in all the patients and the findings were graded according to Mayo endoscopic score (EMS) and UC endoscopic index of severity (UCEIS). FCP was analyzed in stool samples by means of point-of-care desk-top Quantum Blue® method. Results: There was no significant difference between mean FCP levels in controls and UC patients in remission (р=0.205). Mean FCP in patients with active UC was significantly higher than that in controls (p<0.001) and in patients in remission (p<0.001). FCP significantly correlated with UCEIS (r = 0.869, p<0.001) and EMS (r = 0.814, p<0.001). Conclusion: The strong correlation with endoscopic disease activity suggests that FCP is a useful biomarker for noninvasive diagnosis and monitoring of disease activity in UC patients.

scholarly journals Automatic, computer-aided determination of endoscopic and histological inflammation in patients with mild to moderate ulcerative colitis based on red density

Gut ◽  
2020 ◽  
Vol 69 (10) ◽  
pp. 1778-1786 ◽  
Author(s):  
Peter Bossuyt ◽  
Hiroshi Nakase ◽  
Séverine Vermeire ◽  
Gert de Hertogh ◽  
Tom Eelbode ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Disease Activity ◽  
Objective Evaluation ◽  
Second Phase ◽  
Endoscopic Images ◽  
Severity Scores ◽  
Computer Based ◽  
Index Of Severity ◽  
Using Data ◽  
Histological Factors

BackgroundThe objective evaluation of endoscopic disease activity is key in ulcerative colitis (UC). A composite of endoscopic and histological factors is the goal in UC treatment. We aimed to develop an operator-independent computer-based tool to determine UC activity based on endoscopic images.MethodsFirst, we built a computer algorithm using data from 29 consecutive patients with UC and 6 healthy controls (construction cohort). The algorithm (red density: RD) was based on the red channel of the red-green-blue pixel values and pattern recognition from endoscopic images. The algorithm was refined in sequential steps to optimise correlation with endoscopic and histological disease activity. In a second phase, the operating properties were tested in patients with UC flares requiring treatment escalation. To validate the algorithm, we tested the correlation between RD score and clinical, endoscopic and histological features in a validation cohort.ResultsWe constructed the algorithm based on the integration of pixel colour data from the redness colour map along with vascular pattern detection. These data were linked with Robarts histological index (RHI) in a multiple regression analysis. In the construction cohort, RD correlated with RHI (r=0.74, p<0.0001), Mayo endoscopic subscores (r=0.76, p<0.0001) and UC Endoscopic Index of Severity scores (r=0.74, p<0.0001). The RD sensitivity to change had a standardised effect size of 1.16. In the validation set, RD correlated with RHI (r=0.65, p=0.00002).ConclusionsRD provides an objective computer-based score that accurately assesses disease activity in UC. In a validation study, RD correlated with endoscopic and histological disease activity.

scholarly journals P198 Practical deep learning tool for the scoring of ulcerative colitis disease activity in central reading

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S263-S264
Author(s):  
M Byrne ◽  
J East ◽  
M Iacucci ◽  
S Travis ◽  
R Kalapala ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Trials ◽  
Disease Activity ◽  
Video Quality ◽  
Opinion Leaders ◽  
Subject Matter Experts ◽  
Web Based ◽  
Software Interface ◽  
Index Of Severity

Abstract Background Central Reading Org.& the pharma industry employ subject matter experts(SMEs)to score videos from sites participating in clinical trials for Ulcerative Colitis(UC).As we are developing Artificial Intelligence(AI)models for scoring purposes,we need to build a new software interface that can incorporate these AI models to aid SMEs,making their determination of the scores for each segment of the video & for the video as a whole.We propose a system that reduces the time for SMEs to review & score videos,improving the accuracy of scoring,with the help of our AI models. Methods We built a web-based interface supported by our AI models which can read,write multiple databases & data stores to read & display videos to be scored by a central reader, as well as the associated metadata required to improve the process.User interface shows a timeline with markers for the segments of the colon,with sections that are blurry,poorly prepped,or unscorable highlighted in different colours.While we could also highlight sections of the video with the precise score assigned to it by the AI,this would bias the central reader’s opinion.We hide the precise score generated by our AI models & instead display 3 colours for low,medium or high disease activity.When a video is loaded to be read by the user,the playback marker is set to the first high disease activity section based on known medical indexes such as the Mayo Endoscopic Subscore(MES) & UCEIS(Ulcerative Colitis Endoscopic Index of Severity),usually consists of a few seconds of video & that video is played back continuously in a loop until the reader selects the appropriate score for that section.When the reader saves the section,the software immediately moves the video cursor to the highest scored section of the video.That way the central reader can review only the relevant portions of the video to confirm the score assigned to each segment.If the central reader’s scores do not align well with the AI scores then the software continues to show more sections of the video to the user,including sections it may have labeled as unscorable,that may be scorable. Results The review of the system by 3 key opinion leaders,user experience was positive.Not only does the system allow the reader’s attention to be more efficiently used,but the interface allows both AI & central reader scores to be saved,allowing for the latter to be used iteratively to re-train & improve the underlying AI model(s).Our tool was also used by a gastroenterologist specialist in order to perform video quality assessment & colon sections scoring. Conclusion We developed an AI tool that can be used to improve the efficiency & accuracy of the central reading process in clinical trials for UC.Further work is ongoing to improve the interface.

scholarly journals P545 Calprotectin at week 12 is a predictor for histological remission in ulcerative colitis patients treated with Vedolizumab

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S515-S516
Author(s):  
D Rubstov ◽  
P Kakkadasam Ramaswamy ◽  
J Edwards ◽  
D Shukla ◽  
L Willmann ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Remission ◽  
Real World Setting ◽  
Endoscopic Remission ◽  
Endoscopic Score ◽  
Histological Activity ◽  
Maintenance Of Remission ◽  
Histological Remission ◽  
Endoscopic Assessment

Abstract Background Vedolizumab (VDZ) is a gut-specific α4β7 integrin antagonist that has demonstrated efficacy for induction and maintenance of remission in moderate to severe ulcerative colitis (UC). The aim of this study was to assess the rates of histological remission (HR) in a real-world setting and to identify predictors for histological remission. Methods Retrospective cohort study of all UC patients (≥18 years) initiated on VDZ from 2016 to 2020 was completed. Clinical, biochemical, endoscopic and histologic data were collected. All patients received standard induction therapy with VDZ 300 mg IV at Weeks 0, 2, and 6 and maintained on an 8-weekly regimen. Dose was escalated to a every 4-weekly regimen as per physician’s discretion. A 52-week follow-up was completed on all patients. Endoscopic assessment was carried out between 24 and 52 weeks after commencing VDZ. Histological activity was graded as per Nancy index and histological remission was defined as Nancy grade 0. Endoscopic remission was defined as Mayo endoscopic score = 0. Clinical remission was defined as SCCAI ≤ 5. Results A total of 51 patients [55% female, median age 48 years (IQR 35–60)] were included. 16/51 (34%) were anti-TNF exposed. In 30/51 (59%) patients VDZ was combined with steroids at induction and by week 12 steroids were completely tapered in 14/30 (46.7%) patients. At weeks 12, 24 and 52, 89.6%, 87% and 97.5% of patients, respectively, were in clinical remission. 19/37 (51.3%) patients were in endoscopic remission at end of follow up. Median Nancy score prior to commencing VDZ was 3 (IQR: 2–4) and the median Nancy score at end of follow up was 1 (IQR: 0–2). 19/37 (51.3%) patients achieved HR; 3 patients who were in HR at the time of commencement of VDZ remained in HR at the end of follow up. Median baseline faeces calprotectin (FC) was 320 mcg/g (IQR 45–1000) and was similar in patients who achieved HR and those who did not. Median FC at 12 weeks was 155 mcg/g (45–720) and was significantly lower in patients who achieved HR when compared to patients who did not achieve histological remission (45 vs 420, p 0.028). FC at week 12 predicted histological remission (AUC =0.8667). FC ≥ 200mcg/g at week 12 predicted failure to achieve HR with sensitivity 70%, specificity 100%, PPV 100%, NPV 75%, accuracy 84%. Conclusion Vedolizumab is effective in achieving histological remission and FC ≥ 200 mcg/g at week 12 accurately predicts failure to achieve HR in patients treated with VDZ.

Validation of the Ulcerative Colitis Colonoscopic Index of Severity and Its Correlation With Disease Activity Measures

2013 ◽  
Vol 11 (1) ◽  
pp. 49-54.e1 ◽  
Author(s):  
Sunil Samuel ◽  
David H. Bruining ◽  
Edward V. Loftus ◽  
Kelvin T. Thia ◽  
Kenneth W. Schroeder ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Disease Activity ◽  
Activity Measures ◽  
Index Of Severity ◽  
Disease Activity Measures

scholarly journals P561 Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and Mayo Endoscopic Score (MES) in predicting the therapeutic effect of mesalazine in UC patients

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S524-S525
Author(s):  
L Wu ◽  
Y Zhang ◽  
Q Cao
Keyword(s):  
Ulcerative Colitis ◽  
High Probability ◽  
Primary Outcome ◽  
Demographic Data ◽  
Clinical Observations ◽  
Previous Therapy ◽  
Endoscopic Score ◽  
Index Of Severity ◽  
Roc Area

Abstract Background The Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and the Mayo Endoscopic Score (MES) were developed as an objective method of the endoscopic severity in ulcerative colitis (UC); however, it was still unclear whether UCEIS and MES could guide the mesalazine treatment in UC. Methods Consecutive UC patients who had undergone colonoscopy within 1 month before starting mesalazine between October 2011 and July 2016 were retrospectively evaluated. Demographic data, previous therapy, clinical observations, laboratory parameters, medical therapy and endoscopic assessments were documented. The primary outcome was the need for ‘step up’ treatment (containing the use of corticosteroids, immunomodulatory or surgery.) during admission and follow-up. Results Sixty-five patients were enrolled, 12(18.5%) needed ‘step up’ treatment’ due to primary or secondary nonresponse to mesalazine. UCEIS score is a predictor of primary or secondary nonresponse to mesalazine in multivariate analysis (OR, 25.65; 95% CI, 3.048–45.985; P =0.003). Receiver-operator characteristic (ROC) area of UCEIS is 0.95, with a sensitivity of 100% and specificity of 84.6%, using cut-off value of 6, which outperforms MES with the ROC area of 0.70; When UCEIS score ≥6, 60% of patients eventually need ‘step up’ treatment. Conclusion UCEIS score is a useful instrument for evaluating endoscopic improvement in UC patients treated with mesalazine. The high probability of mesalazine treatment failure and benefits of other therapy should be discussed in patients with baseline UCEIS ≥ 6.

scholarly journals Clinical Characterization of Ulcerative Colitis in Patients with Primary Sclerosing Cholangitis

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Shun Murasugi ◽  
Ayumi Ito ◽  
Teppei Omori ◽  
Shinichi Nakamura ◽  
Katsutoshi Tokushige
Keyword(s):  
Ulcerative Colitis ◽  
Primary Sclerosing Cholangitis ◽  
Sclerosing Cholangitis ◽  
Prognostic Impact ◽  
Asymptomatic Patients ◽  
Younger Age ◽  
Endoscopic Score ◽  
Index Of Severity ◽  
Backwash Ileitis ◽  
The Right

Objectives. The clinical/colonoscopic features of ulcerative colitis (UC) associated with primary sclerosing cholangitis (PSC), the prognostic impact of UC, and the utility of UC screening in PSC patients are unknown. We characterized UC associated with PSC and assessed UC’s impact on the prognosis of PSC and the importance of colonoscopic UC screening in PSC patients. Methods. We retrospectively analyzed the cases of 77 patients treated for PSC at a single center (April 2000–July 2019). We reviewed the clinical/colonoscopic profiles of the concurrent UC patients and compared the clinical profiles, survival, and primary causes of death between the patients with/without UC ( n = 35 / n = 42 ). The details of all patients’ colonoscopies were reviewed. Results. The concurrent UC group: 17 men, 18 women, diagnosed with PSC at the mean (SD) age of 36 (17) years; 21 patients (60%) had no UC symptoms. Colonoscopy revealed pancolitis in all patients, predominantly affecting the right-sided colon in 30 patients (86%). Lesions were scattered. Backwash ileitis ( n = 13 , 37%) and rectal sparing ( n = 18 , 51%) were observed. Most patients had mild UC; some had moderate or more severe UC (median Ulcerative Colitis Endoscopic Index of Severity (UCEIS) score 2; range, 1–5). Ludwig’s stage determined by liver biopsy did not correlate with the Mayo endoscopic score for UC. The patients with UC were diagnosed with PSC at a significantly younger age than those without UC (mean (SD), 36 [17] years vs. 55 [19] years, p < 0.0001 ) and had a significantly higher 5-year survival rate (97.1% vs. 70.5%, p = 0.0028 ). UC was detected in 19 of 34 asymptomatic patients (56%) who underwent colonoscopy screening. Conclusions. Our cohort’s clinical/colonoscopic features of UC associated with PSC are more moderate or severe UC than previous cases. The coexistence of UC might affect the prognosis of PSC. In this regard, colonoscopy in PSC patients is an important examination for determining prognosis. There is also asymptomatic UC in patients with PSC. In this regard, screening for colonoscopy in PSC patients is essential. When a diagnosis of PSC is made, immediate colonoscopy is a priority with UC complications in mind.

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