The Lewis score or the capsule endoscopy Crohn’s disease activity index: which one is better for the assessment of small bowel inflammation in established Crohn’s disease?

Abstract

BackgroundSmall-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.MethodsPatients 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.ResultsA total of 50 patients were included in the study. There was a moderate correlation between the worst segment LS and CECDAI (Pearson’s r = 0.66, p = 0.001), and a strong correlation between C-LS and CECDAI (r = 0.81, p = 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 (r = 0.39, p = 0.002 for LS, r = 0.48, p = 0.001 for C-LS, and r = 0.53, p = 0.001 for CECDAI, respectively). CRP levels were not significantly correlated with either score.ConclusionsCECDAI and C-LS are strongly correlated and perform similarly for quantitative assessment of mucosal inflammation in established CD.

Correlation of the endoscopic findings for small and large bowels in pediatric patients with established Crohn’s disease

“…Several studies reported the correlation between SBCE findings and biomarkers including CRP, ESR, and fecal calprotectin levels. (19)(20)(21)(22)(23)(24)(25)(36)(37)(38)(39)(40)(41)(42)(43) The current study indicated that the Lewis score and CECDAI had significant correlations with CRP, ESR, Alb, and fecal calprotectin levels in colonic inactive group. In addition, there was a strong correlation between fecal calprotectin levels and the Lewis score in the colonic inactive group.…”

Small bowel capsule endoscopy and treat-to-target in Crohn's disease: A systematic review

“…This score was validated in 2012 in a cohort of 50 patients with known SB CD[23]. Two recent studies showed a significant correlation between the Lewis and CECDAI scores in patients with known SB CD, with correlation coefficients of r = 0.632 ( P < 0.0001)[24] and r = 0.81 ( P = 0.0001)[25], respectively. Lewis score thresholds of 135 and 790 correspond with CECDAI levels of 3.8 and 5.8, respectively[24].…”

“…However, the Lewis score was weakly correlated with clinical activity as measured by the Harvey Bradshaw index ( r = 0.213, P = 0.019) and no correlation was found between CD activity index (CDAI) and the CECDAI[23]. The Lewis score moderately correlated with C-reactive protein ( r = 0.326, P < 0.001)[27], and a moderate correlation was demonstrated between SBCE scores and fecal calprotectin ( r = 0.48, P = 0.001 for Lewis score, and r = 0.53, P = 0.001 for CECDAI)[25].…”

Capsule endoscopy in inflammatory bowel disease: when and how

“…26 Another study also found a strong correlation between the 2 scores, but only moderate correlation with fecal calprotectin (FC). 27 However, there is no gold standard or widely accepted best scoring system in practice as of now.…”

“…There was a strong correlation between the 2 scores, but the CECDAI was more reflective of extensive inflammation and high clinical activity [ 26 ]. Another study also found a strong correlation between the 2 scores, but only moderate correlation with fecal calprotectin (FC) [ 27 ]. However, there is no gold standard or widely accepted best scoring system in practice as of now.…”