Histopathology Scoring Systems of Stenosis Associated With Small Bowel Crohn's Disease: A Systematic Review
- Ilyssa O Gordon 1, Dominik Bettenworth 2, Arne Bokemeyer 2, Amitabh Srivastava 3, Christophe Rosty 4, Gert de Hertogh 5, Marie E Robert 6, Mark A Valasek 7, Ren Mao 8, Satya Kurada 9, Noam Harpaz 10, Paula Borralho 11, Reetesh K Pai 12, Rish K Pai 13, Robert Odze 14, Roger Feakins 15, Claire E Parker 16, Tran Nguyen 16, Vipul Jairath 17, Mark E Baker 18, David H Bruining 19, J G Fletcher 20, Brian G Feagan 17, Florian Rieder 9,
- 1Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
- 2Department of Medicine B, Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany.
- 3Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts.
- 4Department of Clinical Pathology, The University of Melbourne, Parville, Victoria, Australia; Envoi Specialist Pathologists, Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
- 5Department of Pathology, University Hospital Leuven, Leuven, Belgium.
- 6Department of Pathology, Yale University School of Medicine, New Haven, Connecticut.
- 7Department of Pathology, University of California San Diego, La Jolla, California.
- 8Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
- 9Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute; Cleveland Clinic Foundation, Cleveland, Ohio.
- 10Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
- 11Faculdade de Medicina da Universidade de Lisboa, Instituto de Anatomia Patológica, Lisbon, Portugal.
- 12Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
- 13Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona.
- 14Pathology Department, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
- 15Department of Cellular Pathology, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom.
- 16Robarts Clinical Trials, Inc, London, Ontario, Canada.
- 17Robarts Clinical Trials, Inc, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada; Department of Biostatistics and Epidemiology, Western University, London, Ontario, Canada.
- 18Department of Diagnostic Radiology, Imaging Institute, Digestive Diseases and Surgery Institute, Cleveland, Ohio; Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
- 19Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota.
- 20Department of Radiology, Mayo Clinic, Rochester, Minnesota.
- 0Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
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View abstract on PubMed
Summary
This summary is machine-generated.Current methods for assessing Crohn's disease (CD) stenosis lack validation. Developing reliable histopathology scoring systems is crucial for evaluating new antifibrotic therapies and improving patient outcomes in CD management.
Area Of Science
- Gastroenterology
- Pathology
- Medical Imaging
Background
- Stenosis is a frequent complication of Crohn's disease (CD) with limited medical treatment options.
- Cross-sectional imaging like CT enterography and MR enterography are potential outcome measures for antifibrotic drug trials.
- Histopathology of resected tissue is the reference standard for inflammation and fibrosis in CD stenosis.
Purpose Of The Study
- To systematically review and assess the validity of existing histopathologic scoring systems for stenosing Crohn's disease.
- To identify the limitations of current histopathologic grading in evaluating fibromuscular stenosis and inflammation in CD.
Main Methods
- A comprehensive systematic search of Embase and MEDLINE databases was conducted up to March 13, 2019.
- Included studies evaluated inflammatory and fibrotic alterations in the small bowel of adult CD patients using a histopathology scoring system.
- Scoring systems were analyzed for their adherence to modern principles of index development and validation.
Main Results
- Significant heterogeneity was found among the reviewed histopathology scoring systems.
- None of the assessed scoring systems were developed using modern principles or underwent formal validity and reliability testing.
- Key pathological components, such as myofibroblast changes, lack specific indices for evaluation.
Conclusions
- There is a critical lack of validated histopathologic scoring systems for assessing fibromuscular stenosis in Crohn's disease.
- The reliability of current cross-sectional imaging techniques for stenosing CD is questionable due to the absence of validated reference standards.
- Developing and validating a robust histopathology index is an urgent research priority for advancing CD treatment.
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