Patient self-reported symptoms using visual analog scales are useful to estimate endoscopic activity in ulcerative colitis = Patient self-reported symptoms using visual analog scales are useful to estimate endoscopic activity in ulcerative colitis

다국어 초록 (Multilingual Abstract)

Background/Aims: In clinical practice, colonoscopy has been regarded as the gold standard for the evaluation of disease severity as well as mucosal healing in ulcerative colitis (UC). Some activity indices incorporating patient symptoms as parameters have been shown to reflect the endoscopic activity of UC. The aim of this study was to examine whether self-reported symptoms with visual analog scales (VAS) can predict endoscopic activity. Methods: A cross-sectional study of 150 UC patients who underwent colonoscopy with submission of VAS scores of 4 symptoms: general condition, bloody stools, stool form, and abdominal pain (0: no symptoms, 10: the most severe symptoms). Each VAS score was compared with colonoscopic activity assessed with the Mayo endoscopic subscore (MES). Results: All VAS scores were significantly correlated with the endoscopic severity (Spearman correlation coefficients of general condition, bloody stools, stool form, and abdominal pain: 0.63, 0.64, 0.58, and 0.43, respectively). Mucosal healing defined as MES 0 alone was predicted by VAS score <1.5 on general condition or 0 on bloody stools with sensitivity of 0.84 and 0.76 and specificity of 0.66 and 0.76, respectively. Additionally, VAS score <2.5 on stool form predicted active lesions in distal colorectum alone with sensitivity of 0.67 and specificity of 0.66, suggesting that this item could predict the indication of topical therapy. Conclusions: Self-reported VAS scores on symptoms were correlated with endoscopic activity of UC. To clarify the relationship between VAS and mucosal healing, further validation studies are needed. (Intest Res 2018;16:579-587)

참고문헌 (Reference)

1 Lewis JD, "Use of the noninvasive components of the Mayo score to assess clinical response in ulcerative colitis" 14 : 1660-1666, 2008

2 Schoepfer AM, "Ulcerative colitis: correlation of the Rachmilewitz endoscopic activity index with fecal calprotectin, clinical activity, C-reactive protein, and blood leukocytes" 15 : 1851-1858, 2009

3 Dignass A, "Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 1: definitions and diagnosis" 6 : 965-990, 2012

4 Hanai H, "Relationship between fecal calprotectin, intestinal inflammation, and peripheral blood neutrophils in patients with active ulcerative colitis" 49 : 1438-1443, 2004

5 Bessissow T, "Prognostic value of serologic and histologic markers on clinical relapse in ulcerative colitis patients with mucosal healing" 107 : 1684-1692, 2012

6 Nakarai A, "Prognosis of ulcerative colitis differs between patients with complete and partial mucosal healing, which can be predicted from the platelet count" 20 : 18367-18374, 2014

7 Kuriyama M, "Prediction of flare-ups of ulcerative colitis using quantitative immunochemical fecal occult blood test" 16 : 1110-1114, 2010

8 Kristensen V, "Prediction of endoscopic disease activity in ulcerative colitis by two different assays for fecal calprotectin" 9 : 164-169, 2015

9 Langhorst J, "Noninvasive markers in the assessment of intestinal inflammation in inflammatory bowel diseases: performance of fecal lactoferrin, calprotectin, and PMN-elastase, CRP, and clinical indices" 103 : 162-169, 2008

10 Riley SA, "Microscopic activity in ulcerative colitis: what does it mean?" 32 : 174-178, 1991

11 Huskisson EC, "Measurement of pain" 2 : 1127-1131, 1974

12 Kato J, "Is sigmoidoscopy sufficient for evaluating inflammatory status of ulcerative colitis patients?" 26 : 683-687, 2011

13 D'Haens G, "Fecal calprotectin is a surrogate marker for endoscopic lesions in inflammatory bowel disease" 18 : 2218-2224, 2012

14 Nakarai A, "Evaluation of mucosal healing of ulcerative colitis by a quantitative fecal immunochemical test" 108 : 83-89, 2013

15 Takashima S, "Evaluation of mucosal healing in ulcerative colitis by fecal calprotectin vs. fecal immunochemical test" 110 : 873-880, 2015

16 Ricanek P, "Evaluation of disease activity in IBD at the time of diagnosis by the use of clinical, biochemical, and fecal markers" 46 : 1081-1091, 2011

17 Colombel JF, "Early mucosal healing with infliximab is associated with improved long-term clinical outcomes in ulcerative colitis" 141 : 1194-1201, 2011

18 Colombel JF, "Discrepancies between patient-reported outcomes, and endoscopic and histological appearance in UC" 66 : 2063-2068, 2017

19 Travis SP, "Developing an instrument to assess the endoscopic severity of ulcerative colitis: the Ulcerative Colitis Endoscopic Index of Severity (UCEIS)" 61 : 535-542, 2012

20 Lichtiger S, "Cyclosporine in severe ulcerative colitis refractory to steroid therapy" 330 : 1841-1845, 1994

21 Yoon JY, "Correlations of C-reactive protein levels and erythrocyte sedimentation rates with endoscopic activity indices in patients with ulcerative colitis" 59 : 829-837, 2014

22 Powell-Tuck J, "Correlations between defined sigmoidoscopic appearances and other measures of disease activity in ulcerative colitis" 27 : 533-537, 1982

23 Karoui S, "Correlation of C-reactive protein with clinical and endoscopic activity in patients with ulcerative colitis" 56 : 1801-1805, 2011

24 Seo M, "Correlation between endoscopic severity and the clinical activity index in ulcerative colitis" 93 : 2124-2129, 1998

25 Schroeder KW, "Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis: a randomized study" 317 : 1625-1629, 1987

26 Rachmilewitz D, "Coated mesalazine (5-aminosalicylic acid) versus sulphasalazine in the treatment of active ulcerative colitis: a randomised trial" 298 : 82-86, 1989

27 Yokoyama K, "Clinical study of the relation between mucosal healing and long-term outcomes in ulcerative colitis" 2013 : 192794-, 2013

28 Pineton de Chambrun G, "Clinical implications of mucosal healing for the management of IBD" 7 : 15-29, 2010

29 D'Inca R, "Calprotectin and lactoferrin in the assessment of intestinal inflammation and organic disease" 22 : 429-437, 2007

30 Roseth AG, "Assessment of disease activity in ulcerative colitis by faecal calprotectin, a novel granulocyte marker protein" 58 : 176-180, 1997

31 Pagnini C, "Application of clinical indexes in ulcerative colitis patients in regular follow-up visit: correlation with endoscopic 'mucosal healing' and implication for management. Preliminary results" 19 : 3674-3681, 2015

32 Turner D, "A systematic prospective comparison of noninvasive disease activity indices in ulcerative colitis" 7 : 1081-1088, 2009

33 Walmsley RS, "A simple clinical colitis activity index" 43 : 29-32, 1998

34 Sutherland LR, "5-Aminosalicylic acid enema in the treatment of distal ulcerative colitis, proctosigmoiditis, and proctitis" 92 : 1894-1898, 1987