Published online May 14, 2017. doi: 10.3748/wjg.v23.i18.3322
Peer-review started: October 28, 2016
First decision: December 19, 2016
Revised: January 10, 2017
Accepted: April 12, 2017
Article in press: April 12, 2017
Published online: May 14, 2017
To investigate of pediatric ulcerative colitis activity index (PUCAI) in ulcerative colitis correlate with mucosal inflammation and endoscopic assessment of disease activity (Mayo endoscopic score).
We reviewed charts from ulcerative colitis patients who had undergone both colonoscopy over 3 years. Clinical assessment of disease severity within 35 d (either before or after) the colonoscopy were included. Patients were excluded if they had significant therapeutic interventions (such as the start of corticosteroids or immunosuppressive agents) between the colonoscopy and the clinical assessment. Mayo endoscopic score of the rectum and sigmoid were done by two gastroenterologists. Inter-observer variability in Mayo score was assessed.
We identified 99 patients (53% female, 74% pancolitis) that met inclusion criteria. The indications for colonoscopy included ongoing disease activity (62%), consideration of medication change (10%), assessment of medication efficacy (14%), and cancer screening (14%). Based on PUCAI scores, 33% of patients were in remission, 39% had mild disease, 23% had moderate disease, and 4% had severe disease. There was “moderate-substantial” agreement between the two reviewers in assessing rectal Mayo scores (kappa = 0.54, 95%CI: 0.41-0.68).
Endoscopic disease severity (Mayo score) assessed by reviewing photographs of pediatric colonoscopy has moderate inter-rater reliability, and agreement was less robust in assessing patients with mild disease activity. Endoscopic disease severity generally correlates with clinical disease severity as measured by PUCAI score. However, children with inflamed colons can have significant variation in their reported clinical symptoms. Thus, assessment of both clinical symptoms and endoscopic disease severity may be required in future clinical studies.
Core tip: There is controversy regarding what the best method of assessing disease activity in pediatric ulcerative colitis. Currently, the best accepted tool is the pediatric ulcerative colitis activity index (PUCAI), developed by Turner and colleagues, which is a physician reported measure. Because of its formal validation and ease of use, the PUCAI has been widely accepted both as a clinical tool by physicians. Other experts have suggested that biomarkers, patient reported outcomes, or endoscopic disease activity may be better measures. In this study, we show physicians looking at endoscopic photos may grade the Mayo endoscopic scores differently, and that the PUCAI generally correlates well with endoscopic disease activity.