BACKGROUND: Subjective physician assessment is the cornerstone of routine ulcerative colitis (UC) management. Endoscopic and histologic assessment of UC provides objective measures of inflammatory disease activity. The level of agreement between physician impression of UC activity and endoscopic disease activity has not been evaluated. The aim was to assess the level of agreement between physician's clinical impression of UC disease activity and endoscopic and histologic findings of inflammation. METHODS: Using the Medical Archival Retrieval System at the University of Pittsburgh Medical Center, we reviewed clinical information on all UC patients between 1995 and 2008 who had clinic visits recorded prior to colonoscopy. Clinical UC disease activity was defined by the physician's clinical impression and the endoscopic and histologic activity by colonoscopy with biopsy. The level of agreement between colonoscopy assessment of UC with histologic and clinical assessment was determined by sensitivity, specificity, positive and negative predictive values, and the kappa coefficient. RESULTS: There were 369 UC patients who had a clinic visit proximate to a colonoscopy. The mean age of patients was 46 ± 16 years (50% female). The performance of clinical impression in recognizing disease activity, as determined by endoscopy, was relatively poor: sensitivity = 56.0%, predictive value negative = 56.8%, kappa coefficient = 0.35. In contrast, the performance of histological evaluation in recognizing disease activity was markedly better: sensitivity = 93.5%, predictive value negative = 89.1%, kappa coefficient = 0.70. CONCLUSIONS: The physician's clinical impression of UC activity shows poor agreement with endoscopy and histology, with over one-third of patients with chronic inflammation underrecognized by clinical impression. The consequences of underestimated UC activity by clinical assessment may include undertreatment of active disease and uncontrolled chronic inflammation.
BACKGROUND: Subjective physician assessment is the cornerstone of routine ulcerative colitis (UC) management. Endoscopic and histologic assessment of UC provides objective measures of inflammatory disease activity. The level of agreement between physician impression of UC activity and endoscopic disease activity has not been evaluated. The aim was to assess the level of agreement between physician's clinical impression of UC disease activity and endoscopic and histologic findings of inflammation. METHODS: Using the Medical Archival Retrieval System at the University of Pittsburgh Medical Center, we reviewed clinical information on all UC patients between 1995 and 2008 who had clinic visits recorded prior to colonoscopy. Clinical UC disease activity was defined by the physician's clinical impression and the endoscopic and histologic activity by colonoscopy with biopsy. The level of agreement between colonoscopy assessment of UC with histologic and clinical assessment was determined by sensitivity, specificity, positive and negative predictive values, and the kappa coefficient. RESULTS: There were 369 UC patients who had a clinic visit proximate to a colonoscopy. The mean age of patients was 46 ± 16 years (50% female). The performance of clinical impression in recognizing disease activity, as determined by endoscopy, was relatively poor: sensitivity = 56.0%, predictive value negative = 56.8%, kappa coefficient = 0.35. In contrast, the performance of histological evaluation in recognizing disease activity was markedly better: sensitivity = 93.5%, predictive value negative = 89.1%, kappa coefficient = 0.70. CONCLUSIONS: The physician's clinical impression of UC activity shows poor agreement with endoscopy and histology, with over one-third of patients with chronic inflammation underrecognized by clinical impression. The consequences of underestimated UC activity by clinical assessment may include undertreatment of active disease and uncontrolled chronic inflammation.
Authors: Robert Battat; Parambir S Dulai; Christopher Ma; Vipul Jairath; Brian G Feagan; William J Sandborn; Reena Khanna Journal: Curr Treat Options Gastroenterol Date: 2020-01-04
Authors: Balakrishnan S Ramakrishna; Govind K Makharia; Philip Abraham; Uday C Ghoshal; Venkataraman Jayanthi; Brij Kishore Agarwal; Vineet Ahuja; Deepak K Bhasin; Shobna J Bhatia; Gourdas Choudhuri; Sunil Dadhich; Devendra C Desai; Gopal Krishna Dhali; Bhaba Dev Goswami; Sanjeev K Issar; Ajay K Jain; Rakesh Kochhar; Ajay Kumar; Goundappa Loganathan; Sri Prakash Misra; C Ganesh Pai; Sujoy Pal; Anna Pulimood; Amarender S Puri; Ganesh N Ramesh; Gautam Ray; Shivaram P Singh; Ajit Sood; Manu Tandan Journal: Indian J Gastroenterol Date: 2012-10-25
Authors: Triana Lobatón; Talat Bessissow; Alexandra Ruiz-Cerulla; Gert De Hertogh; Raf Bisschops; Jordi Guardiola; Gert Van Assche; Severine Vermeire; Marc Ferrante Journal: United European Gastroenterol J Date: 2018-01-08 Impact factor: 4.623
Authors: Basavaraj Kerur; Heather J Litman; Julia Bender Stern; Sarah Weber; Jenifer R Lightdale; Paul A Rufo; Athos Bousvaros Journal: World J Gastroenterol Date: 2017-05-14 Impact factor: 5.742