Yablecovitch Doron, Lahat Adi, Neuman Sandra, Levhar Nina, Avidan Benjamin, Ben-Horin Shomron, Eliakim Rami, Kopylov Uri
Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel, and Sackler School of Medicine, Tel Aviv University, Israel.
Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, 52621, Israel.
Therap Adv Gastroenterol. 2018 Jan 14;11:1756283X17747780. doi: 10.1177/1756283X17747780. eCollection 2018.
Small-bowel capsule endoscopy (CE) is a prime modality for evaluation of the small bowel. The Lewis score (LS) and the Capsule Endoscopy Crohn's Disease Activity Index (CECDAI) are validated endoscopic indices for quantification of small-bowel inflammation on CE. It is unclear whether these indexes are interchangeable for the evaluation of mucosal inflammation in established Crohn's disease (CD). The aim of this study was to compare the quantitative evaluation of small- bowel inflammation by LS and CECDAI.
Patients with known quiescent small-bowel CD for at least 3 months (Crohn's disease activity index < 150) were prospectively recruited and underwent CE. The LS was calculated using RAPID 8 capsule-reading software and the CECDAI was calculated manually. Cumulative LS (C-LS) was calculated by summation of individual tertile LS. Fecal calprotectin (FCP) and C-reactive protein (CRP) levels were measured and correlated with the scores.
A total of 50 patients were included in the study. There was a moderate correlation between the worst segment LS and CECDAI (Pearson's = 0.66, = 0.001), and a strong correlation between C-LS and CECDAI ( = 0.81, = 0.0001). CECDAI < 5.4 corresponded to mucosal healing (LS < 135), while CECDAI > 9.2 corresponded to moderate-to-severe inflammation (LS ⩾ 790). There was a moderate correlation between capsule scores and FCP levels ( = 0.39, = 0.002 for LS, = 0.48, = 0.001 for C-LS, and = 0.53, = 0.001 for CECDAI, respectively). CRP levels were not significantly correlated with either score.
CECDAI and C-LS are strongly correlated and perform similarly for quantitative assessment of mucosal inflammation in established CD.
小肠胶囊内镜检查（CE）是评估小肠的主要方式。Lewis评分（LS）和胶囊内镜克罗恩病活动指数（CECDAI）是用于量化CE上小肠炎症的经过验证的内镜指数。目前尚不清楚这些指数在评估已确诊的克罗恩病（CD）的黏膜炎症时是否可互换。本研究的目的是比较LS和CECDAI对小肠炎症的定量评估。
前瞻性招募已知小肠CD静止至少3个月（克罗恩病活动指数<150）的患者并进行CE。使用RAPID 8胶囊阅读软件计算LS，手动计算CECDAI。累积LS（C-LS）通过各个三分位数LS的总和计算。测量粪便钙卫蛋白（FCP）和C反应蛋白（CRP）水平并将其与评分相关联。
本研究共纳入50例患者。最差节段LS与CECDAI之间存在中度相关性（Pearson's = 0.66， = 0.001），C-LS与CECDAI之间存在强相关性（ = 0.81， = 0.0001）。CECDAI < 5.4对应黏膜愈合（LS < 135），而CECDAI > 9.2对应中度至重度炎症（LS ⩾ 790）。胶囊评分与FCP水平之间存在中度相关性（LS分别为 = 0.39， = 0.002；C-LS为 = 0.48， = 0.001；CECDAI为 = 0.53， = 0.001）。CRP水平与任何一个评分均无显著相关性。
CECDAI和C-LS密切相关，在对已确诊的CD的黏膜炎症进行定量评估时表现相似。
