Amsterdam UMC, Amsterdam Medical Center, University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, The Netherlands.
Amsterdam UMC, VU Medical Center, VU University, Department of Pathology, Amsterdam, The Netherlands.
J Crohns Colitis. 2020 Jul 9;14(6):734-742. doi: 10.1093/ecco-jcc/jjz177.
In Crohn's disease, many patients develop a stricture, which can due to inflammation, fibrosis and muscular changes or all at the same time. Determining the predominant component has therapeutic consequences but remains challenging. To develop imaging techniques that assess the nature of a stricture, a gold standard is needed and histopathology is considered as such. This paper provides an overview of published histological scoring systems for strictures in Crohn's disease.
A systematic literature review according to PRISMA guidelines was performed of histological scoring indices that assessed whether a stricture was inflammation-predominant or fibrosis-predominant. Multiple libraries were searched from inception to December 2018. Two reviewers independently assessed abstracts and full-texts.
Sixteen articles were identified as suitable for this systematic review. A large number of parameters were reported. Extent of neutrophil infiltration and extent of fibrosis in the bowel wall were most frequently described to reflect severity of inflammation and fibrosis, respectively. Among the 16 studies, only two described a numerical scoring system for the inflammatory and fibrotic component separately. Smooth muscle changes were scored in a minority of studies.
Multiple scoring systems have been developed. There was large heterogeneity in scoring per parameter and construction of numerical scoring systems. Therefore, we feel that none of the systems is suitable to be used as gold standard. We offer an overview of histological parameters that could be incorporated in a future histological scoring index for strictures.
在克罗恩病中，许多患者会出现狭窄，狭窄的原因可能是炎症、纤维化和肌肉变化，或者同时存在。确定主要成分具有治疗意义，但仍具有挑战性。为了开发评估狭窄性质的成像技术，需要一个金标准，而组织病理学被认为是这样的标准。本文概述了用于评估克罗恩病狭窄的组织学评分系统。
根据 PRISMA 指南，对评估狭窄是否以炎症为主或纤维化为主的组织学评分指数进行了系统的文献回顾。从成立到 2018 年 12 月，在多个库中进行了搜索。两位审查员独立评估了摘要和全文。
确定了 16 篇适合本系统评价的文章。报道了大量参数。肠壁中中性粒细胞浸润的程度和纤维化的程度最常被用来分别反映炎症和纤维化的严重程度。在这 16 项研究中，只有两项描述了分别对炎症和纤维化成分进行数字评分系统。少数研究中对平滑肌变化进行了评分。
已经开发了多种评分系统。每个参数的评分和数值评分系统的构建存在很大的异质性。因此，我们认为没有一个系统适合作为金标准。我们提供了一个可能包含在未来狭窄组织学评分指数中的组织学参数概述。
