Capsule endoscopy score accurately measures Crohn's disease activity

Last Updated: 2016-11-10

By Will Boggs MD

NEW YORK (Reuters Health) - A new Crohn's disease activity score based on capsule endoscopy, called CECDAIic or Niv, accurately measures mucosal disease activity in the small bowel and colon, researchers from Israel report.

"I hope that the Niv score will become routine when Crohn's disease activity (needs) to be accurately assessed," Dr. Yaron Niv from Rabin Medical Center at Tel Aviv University in Petach Tikva told Reuters Health by email. "It will be particularly important in severe cases or when there is no clinical improvement on regular treatments."

The CECDAIic was originally developed to measure mucosal disease activity of the small bowel using capsule endoscopy with the PillCam 2.

Dr. Niv's team has now extended the score to include the colon, thereby providing a comprehensive view of the whole intestine of Crohn's disease patients.

The score evaluates three parameters of intestinal pathology:

* Inflammation (A, ranging from 0 = none to 5 = large ulcers)

* Extent of disease (B, ranging from 0 = none to 3 = diffuse disease)

* Presence of strictures (C, ranging from 0 = none to 3 = obstruction)

It combines them using the scoring formula CECDAIic = (A1 x B1 + C1) + (A2 x B2 + C2) + (A3 x B3 + C3) + (A4 x B4 + C4), where 1 = proximal small bowel, 2 = distal small bowel, 3 = right colon, and 4 = left colon.

Five observers assessed the CECDAIic in 10 patients. The median score was 15.5 (range, 0 to 42), and the mean score was 17.2 (standard deviation, 11.5), the researchers report in the Journal of Clinical Gastroenterology, online October 12.

CECDAIic scores per patient were similar among the five observers.

Kendall's coefficients of concordance were significant for the small bowel (0.85) and for the whole intestine (0.77), indicating good agreement among the five observers.

"The Niv score will give the physician accurate information about the present status of the disease," Dr. Niv said. "According to this information a proper treatment will be tailored. In a very active and severe disease (Niv score > 7) a biologic drug such as infliximab will be started, or when complete mucosal healing is diagnosed (Niv score <3) only maintenance therapy will be prescribed."

"I believe that in the future new drugs for Crohn's disease will not be approved without a proper measurement of Niv score, demonstrating mucosal healing," Dr. Niv said.

Dr. Eduardo Rodrigues-Pinto, a gastroenterologist at Centro Hospitalar Sao Joao in Porto, Portugal, told Reuters Health by email, "This simple index may be a non-invasive pan-bowel CD activity measure in a reproducible manner with a low interobserver variation. It may have the potential benefit of assisting in patient management and objective monitoring mucosal healing, without the need of repeating colonoscopies."

However, he cautioned, the device is unable to perform biopsies and differentiate CD flares from other causes of flares.

"This score must also be validated," he added. "Additional studies need to be performed to compare it with other scores and inflammatory markers (erythrocyte sedimentation rate, C-reactive protein, fecal calprotectin) and to determine if this scoring index correlates with overall disease activity and if it is a reliable tool for monitoring mucosal healing."

SOURCE: http://bit.ly/2eF7t2I

J Clin Gastroenterol 2016.