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 20 May 2018

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News

Responsiveness of endoscopic indices of disease activity for Crohn’s disease

A study in the most recent issue of the American Journal of Gastroenterology examines the responsiveness of endoscopic indices of disease activity for Crohn’s disease.

News image

The Crohn’s Disease Endoscopic Index of Severity (CDEIS) and the Simple Endoscopic Score for Crohn’s Disease (SES-CD) are commonly used to assess Crohn’s disease (CD) activity.

However, neither instrument is fully validated.

Dr Geert D'Haens evaluated the responsiveness to change of the SES-CD and CDEIS using data from a trial of adalimumab, a drug therapy of known efficacy.

Paired video recordings of colonoscopies obtained from patients with CD who participated in a trial of adalimumab therapy were reviewed in random order, in duplicate, by 4 central readers.

The researchers evaluated responsiveness of the SES-CD and the CDEIS by comparing correlations between the observed and pre-specified predictions of change scores for these endoscopic indices with a global endoscopic evaluation of severity (GELS), a patient reported outcome, and the Crohn’s disease activity index (CDAI), and by calculation of the standardized effect size, and Guyatt’s Responsiveness statistic (GRS).

Changes in both endoscopic instruments and the GELS were highly correlated
American Journal of Gastroenterology

The team used 2 definitions of change, including treatment assignment and an absolute change in total patient reported outcome of 50.

The researchers found that changes in both endoscopic instruments and the GELS were highly correlated.

The SES-CD displayed numerically higher effect sizes for both definitions of change.

The standardized effect size and GRS estimates for the SES-CD based on treatment assignment were 0.84 and 0.79.

The team observed that corresponding values for the CDEIS were 0.72 and 0.75.

The standardized effect size and GRS estimates for the SES-CD based on an absolute change in total patient reported outcome of 50 points or greater were 0.76, and 0.93.

Corresponding values for CDEIS were 0.70, and 0.83.

The research team noted that removal of stenosis as an index item and adjusting for observed segments did not improve responsiveness estimates.

Dr D'Haens' team concludes, "Although both the SES-CD and CDEIS are valid measures of endoscopic disease activity that are moderately responsive to changes in endoscopic disease activity, the SES-CD displayed numerically greater responsiveness in this data set."

Am J Gastroenterol 2017; 112:1584–1592
20 November 2017

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