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Review article: Crohn's disease: monitoring disease activity
R Sostegni1, M Daperno, N Scaglione
1UOA Gastroenterologia, Ospedale Mauriziano Umberto I, Torino, Italy.
Insights
Currently, no single global measure accurately assesses Crohn's disease activity. This review examines various clinical, endoscopic, and biochemical markers, highlighting their limitations for widespread use.
Area of Science:
- Gastroenterology
- Inflammatory Bowel Disease Research
Background:
- Assessing Crohn's disease activity comprehensively remains a challenge.
- Existing measurement tools often focus on specific disease aspects rather than a global picture.
Purpose of the Study:
- To review and analyze commonly used and validated indices for measuring Crohn's disease activity.
- To evaluate the advantages and disadvantages of various scoring systems.
Main Methods:
- Analysis of clinical indices (e.g., Crohn's Disease Activity Index [CDAI])
- Review of quality of life scores (e.g., Inflammatory Bowel Disease Questionnaire [IBDQ])
- Examination of sub-clinical markers (e.g., C-reactive protein, fecal calprotectin) and endoscopic indices (e.g., Crohn's Disease Endoscopic Index of Severity [CDEIS])
Main Results:
- Multiple indices exist for clinical, endoscopic, biochemical, and quality of life assessments in Crohn's disease.
- Each index has specific advantages and disadvantages, impacting their utility.
- Complexity and time requirements limit the use of most indices to clinical trials.
Conclusions:
- A universally accepted global measurement for Crohn's disease activity is currently unavailable.
- Gastroenterologists often rely on clinical judgment in practice due to the complexity of validated indices.
- Further development may be needed to create more practical and comprehensive assessment tools.
Abstract:
A global measurement of Crohn's disease activity, comprising clinical, endoscopic, biochemical and pathological features is not available yet and perhaps is unobtainable. In this review we analyse the most used and validated clinical indices (Crohn's Disease Activity Index [CDAI], Perianal Disease Activity Index [PDAI], fistula drainage assessment), quality of life scores (Inflammatory Bowel Disease Questionnaire [IBDQ]), sub-clinical markers (C-reactive protein, faecal calprotectin, intestinal permeability) and endoscopic indices (Crohn's Disease Endoscopic Index of Severity [CDEIS]/Simple Endoscopic Score for Crohn's Disease [SES-CD], Rutgeeerts' score for postsurgical recurrence). We also review the main advantages and disadvantages of each of these scoring systems. All these indices are rather complex and time-consuming, therefore their use is limited to clinical trials. In everyday clinical practice most gastroenterologists rely on their global clinical judgement, which is less reproducible, but simpler for decision-making.