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Clinical disease activity and endoscopic severity correlate poorly in children newly diagnosed with Crohn's Disease.

Gastrointest Endosc; 2018 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-30273592

BACKGROUND:

/Aims: Treatment goals in Crohn's disease (CD) have evolved to target mucosal healing. There is now a drive to determine if non-invasive measures can adequately identify the attainment and persistence of this goal. Currently, data describing the relationship between clinical indices and endoscopic appearance in pediatric Crohn's disease (CD) are sparse. Our aim was to compare endoscopic severity with the weighted Pediatric Crohn's Disease Activity Index (wPCDAI) in children with newly diagnosed CD.

METHODS:

All children ≤17 years of age newly diagnosed with CD enrolled in an inception cohort at sites of the Canadian Children Inflammatory Bowel Disease Network (CIDsCaNN) were eligible. Clinical disease activity at presentation was evaluated by wPCDAI and conventional biochemical parameters. Severity of disease at ileocolonoscopy was assessed by the Simple Endoscopic Score for Crohn's disease (SES-CD), with segmental subscores noted. We evaluated the association of SES-CD and disease activity markers using the Pearson test of correlation, the Spearman rank coefficient, and linear regression models.

RESULTS:

Two hundred eighty patients from 11 centers were included in the analysis. The median wPCDAI score was 60 (IQR 40 - 80; 53% severe). Median SES-CD was 16 (IQR 10 - 22; 51% severe). The wPCDAI correlated weakly with SES-CD (r = 0.39, p <0.001). Examination of the individual components that contribute to the wPCDAI demonstrated weak correlation with SES-CD for all items apart from stooling (moderate correlation, r = 0.50 p < 0.001). Routine blood tests did not correlate well with SES-CD. In regression models, variation in clinical symptoms accounted for most of the variation in both wPCDAI and SES-CD, with no additional benefit from routine blood tests.

CONCLUSIONS:

In children with newly diagnosed CD, wPCDAI correlates poorly with endoscopic disease activity. As treatment paradigms evolve to target mucosal healing, clinical markers should not be used in isolation to determine disease activity.