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Assessment of a new score for capsule endoscopy in pediatric Crohn's disease (CE-CD)
Salvatore Oliva1, Silvio Veraldi1, Salvatore Cucchiara1
1Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza University, Rome, Italy.
Insights
A new score, capsule endoscopy-Crohn's disease index (CE-CD), effectively evaluates pediatric Crohn's disease (CD) small bowel inflammation. This reliable CE-CD score predicts disease activity and outcomes, offering a valuable tool for pediatric CD management.
Area of Science:
- Gastroenterology
- Pediatric Gastroenterology
- Medical Imaging
Background:
- Existing capsule endoscopy (CE) scores for Crohn's disease (CD), Lewis score (LS) and Capsule Endoscopy Crohn's Disease Activity Index (CECDAI), have limitations, especially in pediatric populations.
- Standardization and validation of CE findings are crucial for accurate pediatric CD assessment.
Purpose of the Study:
- To assess a novel score, capsule endoscopy-Crohn's disease index (CE-CD), for evaluating small bowel inflammation in pediatric CD patients.
- To compare the performance of the CE-CD score against existing scores (LS and CECDAI) and its ability to predict clinical outcomes.
Main Methods:
- A retrospective, double-center study involving 312 pediatric CD patients who underwent CE.
- Correlation analyses were performed between CE-CD, LS, CECDAI, and noninvasive disease markers.
- Regression and survival analyses evaluated the predictive ability of CE scores for clinical and endoscopic outcomes.
Main Results:
- The CE-CD score demonstrated strong associations with CECDAI (r=0.909) and moderate association with LS (r=0.581).
- CE-CD was a significant predictor of hospitalization, treatment escalation, steroid therapy, and clinical/endoscopic relapse over 24 months (P < 0.001).
- Pediatric patients with CE-CD scores ≥9 (indicating inflammation) experienced significantly worse outcomes compared to those with scores <9 (P < 0.001).
Conclusions:
- The CE-CD score is a simple, reliable, reproducible, and predictive tool for assessing small bowel inflammation in pediatric CD.
- The CE-CD score demonstrates significant predictive value for disease activity and future outcomes in pediatric CD patients.
- Prospective validation is recommended to confirm the clinical utility of the CE-CD score in practice.
Abstract:
Background and study aims Two scores have been implemented to standardize capsule endoscopic (CE) findings in patients with Crohn's disease (CD): Lewis score (LS) and Capsule Endoscopy Crohn's Disease Activity Index (CECDAI). Both have limitations and are not well validated in the pediatric population. The aim of our study was to assess a new score (capsule endoscopy - Crohn's disease index, CE-CD) in pediatric patients with CD and to compare it to preexisting scores. Patients and methods This was a double-center, retrospective study involving pediatric subjects with CD who underwent CE. Correlation analyses between CE-CD, endoscopy scores and noninvasive markers of disease activities were performed. The ability of different CE scores to predict clinical and endoscopic outcomes was evaluated with regression and survival analyses. Results A total of 312 subjects were analyzed. The CE-CD score showed a moderate (Pearson's r = 0.581, P < 0.001) and strong (r = 0.909, P < 0.001) association with LS and CECDAI, respectively. CE-CD was a statistically significant predictor of hospitalization (hazard ratio [HR]1.061), treatment escalation (HR 1.062), steroid therapy (HR 1.082), clinical (HR 1.064) and endoscopic (HR 1.060) relapse over the twenty-four months ( P < 0.001). Subjects with mucosal inflammation according to CE-CD (CE-CD ≥ 9) had worse outcomes compared to patients without inflammation (CE-CD < 9) (Log rang test < 0.001). Conclusions The CE-CD score is a simple, reliable, reproducible, and predictive score for evaluation of small bowel inflammation in pediatric patients with CD. Prospective validation is needed to confirm the applicability of this new index in clinical practice.
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