The Ulcerative Colitis Endoscopic Index of Severity More Accurately Reflects Clinical Outcomes and Long-term Prognosis than the Mayo Endoscopic Score

Ikeya, Kentaro; Hanai, Hiroyuki; Sugimoto, Ken; Osawa, Satoshi; Kawasaki, Shinsuke; Iida, Takayuki; Maruyama, Yasuhiko; Watanabe, Fumio

doi:10.1093/ecco-jcc/jjv210

Cited by 135 publications

(124 citation statements)

References 36 publications

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“…The severity of UC is often presented by clinical activity indices (CAI), which are described by several authors . Another, but complementary parameter is endoscopic index (EI), a true reflection of mucosal damage, or otherwise mucosal remission . In CD patients, the activity index (CDAI) is assessed by a different set of measurements .…”

Section: Introductionmentioning

confidence: 99%

Granulomonocytapheresis as a cell‐dependent treatment option for patients with inflammatory bowel disease: Concepts and clinical features for better therapeutic outcomes

Saniabadi

Tanaka

Yamamoto

et al. 2018

J of Clinical Apheresis

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Ulcerative colitis (UC) and Crohn's disease (CD) are major phenotypes of the chronic inflammatory bowel disease (IBD), which afflicts millions of individuals throughout the world with debilitating symptoms. The chronic nature of IBD means that patients require life‐long medications, and this may lead to drug dependency, loss of response together with adverse side effects as additional morbidity factors. The efficacy of antitumour necrosis factor (TNF)‐α biologics has validated the role of inflammatory cytokines notably TNF‐α in the exacerbation and perpetuation of IBD. However, cytokines are released by myeloid lineage leucocytes like the CD14+CD16+ monocyte phenotype. Additionally in IBD, myeloid leucocytes are elevated with activation behavior, while lymphocytes are compromised. Therefore, patients' leucocytes appear logical targets of therapy. Adsorptive granulomonocytapheresis (GMA) with an Adacolumn uses carriers, which interact with the Fcγ receptor expressing leucocytes and deplete the elevated myeloid leucocytes, while the neutrophils, which re‐enter the circulation via the Adacolumn outflow (≥40%) are phagocytosed by CD19 B‐cells to become interleukin (IL)‐10 producing Bregs or CD19highCD1Dhigh B‐cells. IL‐10 is an anti‐inflammatory cytokine. GMA has been applied to treat patients with IBD. The efficacy outcomes have been impressive as well as disappointing, the clinical response to GMA defines the patients' disease course and severity at entry. Efficacy outcomes in patients with deep ulcers together with extensive loss of the mucosal tissue are not encouraging, while patients without these features respond well and attain a favorable long‐term disease course. Accordingly, for responder patients, GMA fulfills a desire to be treated without drugs.

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Section: Introductionmentioning

confidence: 99%

Granulomonocytapheresis as a cell‐dependent treatment option for patients with inflammatory bowel disease: Concepts and clinical features for better therapeutic outcomes

Saniabadi

Tanaka

Yamamoto

et al. 2018

J of Clinical Apheresis

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“…In addition to the more detailed scoring of the extent of ulcers compared to MES, UCIES includes the degree of vascular appearance. Indeed, it has been reported that UCEIS precisely reflects clinical outcomes and predicts the medium-to-long-term prognosis in UC patients on induction therapies [16]. However, only few studies have examined the association between fecal markers and UCEIS [17].…”

Section: Introductionmentioning

confidence: 99%

Correlation of Fecal Markers with Magnifying Endoscopic Stratification in Patients with Ulcerative Colitis Who Are in Clinical Remission

et al. 2018

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Background: Maintenance of mucosal healing is recommended during the treatment of ulcerative colitis (UC). However, symptoms of UC often do not reflect mucosal disease activity. Fecal markers such as calprotectin, lactoferrin, and hemoglobin have been reported to correlate well with the Mayo endoscopic subscore (MES) and are being considered alternative monitoring tools in endoscopy. Ulcerative Colitis Endoscopic Index of Severity (UCEIS) is a new and more detailed endoscopic scoring system compared to MES. Furthermore, magnifying endoscopic stratification (ME) based on alterations in the mucosal surface pit patterns is noted in UC. However, the association between fecal markers and UCIES and magnifying endoscopy is relatively unexplored. Summary: This study investigated the association between the aforementioned fecal markers and MES, UCEIS, and ME in patients with UC in clinical remission. This prospective study included 60 patients with UC in clinical remission who underwent colonoscopy at the Nagasaki University Hospital between June 2015 and November 2016. A significant correlation was observed between MES and all fecal markers. Notably, the fecal markers correlated well with UCEIS (calprotectin Spearman’s correlation coefficient [r] = 0.54, p < 0.0001; lactoferrin r = 0.56, p < 0.0001; and hemoglobin r = 0.43, p < 0.001). Furthermore, ME findings correlated significantly with calprotectin (r = 0.50, p = 0.0002) and lactoferrin (r = 0.46, p = 0.0006) levels and slightly with hemoglobin (r = 0.28, p = 0.043) levels. Moreover, each cutoff level of fecal calprotectin, lactoferrin, or hemoglobin had a high sensitivity and specificity for the detection of MES = 0, UCEIS = 0, ME = A, for predicting mucosa healing. Key Messages: Fecal markers correlated not only with MES but also with UCEIS and ME and should be useful for monitoring patients with UC in clinical remission.

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“…Usually at day 5-7 we complement repeat close clinical assessment with endoscopic re-evaluation. Not surprisingly, studies were able to correlate the endoscopic severity of disease with mid-term outcome [9,10], although most trials have used a later time point (e.g. 12 weeks) for reassessment.…”

Section: Short-term Control Of Response To Intensified Therapymentioning

confidence: 99%

Endoscopic Surveillance in Inflammatory Bowel Disease

Goetz¹

2018

Visc Med

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Introduction: Endoscopy is a key technique for the surveillance of patients with inflammatory bowel diseases (Crohn's disease (CD) and ulcerative colitis). Indication to perform endoscopy for surveillance includes assessment of response to therapy, postoperative surveillance, and surveillance for intraepithelial neoplasia. Methods: In addition to personal experience, a literature search was performed and the guidelines were consulted. Results and Conclusion: Endoscopy is the gold standard in the long-term assessment of mucosal healing and in the short-term control of response to intensified therapy. For postoperative surveillance in CD, mucosal changes (as graded by the Rutgeerts score) are predictive of clinical recurrence. For neoplasia surveillance, virtual chromoendoscopy has not (yet) replaced conventional chromoendoscopy. Surveillance can be optimized by the use of high-definition endoscopes as well as (pan-)chromoendoscopy and requires time to scrutinize the mucosa. This approach seems to be superior to random biopsies.

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The Ulcerative Colitis Endoscopic Index of Severity More Accurately Reflects Clinical Outcomes and Long-term Prognosis than the Mayo Endoscopic Score

Cited by 135 publications

References 36 publications

Granulomonocytapheresis as a cell‐dependent treatment option for patients with inflammatory bowel disease: Concepts and clinical features for better therapeutic outcomes

Granulomonocytapheresis as a cell‐dependent treatment option for patients with inflammatory bowel disease: Concepts and clinical features for better therapeutic outcomes

Correlation of Fecal Markers with Magnifying Endoscopic Stratification in Patients with Ulcerative Colitis Who Are in Clinical Remission

Endoscopic Surveillance in Inflammatory Bowel Disease

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