Kerur Basavaraj, Litman Heather J, Stern Julia Bender, Weber Sarah, Lightdale Jenifer R, Rufo Paul A, Bousvaros Athos
Basavaraj Kerur, Pediatric Gastroenterology, Hasbro Children's Hospital, Providence, RI 02903, United States.
World J Gastroenterol. 2017 May 14;23(18):3322-3329. doi: 10.3748/wjg.v23.i18.3322.
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).
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.
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).
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.
研究溃疡性结肠炎患儿的溃疡性结肠炎活动指数（PUCAI）与黏膜炎症及疾病活动度的内镜评估（梅奥内镜评分）之间的相关性。
我们回顾了3年内接受过结肠镜检查的溃疡性结肠炎患者的病历。纳入结肠镜检查前或后35天内疾病严重程度的临床评估。如果患者在结肠镜检查和临床评估之间有重大治疗干预（如开始使用皮质类固醇或免疫抑制剂），则将其排除。由两位胃肠病学家对直肠和乙状结肠进行梅奥内镜评分。评估观察者间梅奥评分的变异性。
我们确定了99名符合纳入标准的患者（53%为女性，74%为全结肠炎）。结肠镜检查的适应证包括疾病持续活动（62%）、考虑药物改变（10%）、评估药物疗效（14%）和癌症筛查（14%）。根据PUCAI评分，33%的患者处于缓解期，39%有轻度疾病，23%有中度疾病，4%有重度疾病。两位评估者在评估直肠梅奥评分时有“中度-高度”一致性（kappa = 0.54，95%CI：0.41-0.68）。
通过回顾儿科结肠镜检查照片评估的内镜疾病严重程度（梅奥评分）具有中等程度的观察者间可靠性，在评估轻度疾病活动的患者时一致性较差。内镜疾病严重程度通常与通过PUCAI评分衡量的临床疾病严重程度相关。然而，结肠发炎的儿童报告的临床症状可能有很大差异。因此，未来的临床研究可能需要同时评估临床症状和内镜疾病严重程度。
