BACKGROUND: Mucosal healing has been proposed as the therapeutic end point in the treatment of patients with ulcerative colitis (UC). OBJECTIVE: To investigate the relationship between physician global assessment (PGA) and laboratory blood tests (complete blood count, ferritin, C-reactive protein, albumin) and endoscopic findings in UC to determine whether they could be adequate surrogates for endoscopy. METHODS: A retrospective chart review of patients known to have UC from July 2008 to November 2012 was performed at the Health Sciences Centre, Winnipeg, Manitoba. Patients included individuals with UC who underwent colonoscopy within one month of clinic assessment. Blood tests were standard at the time of colonoscopy. Patients presenting through the emergency department, those with colonoscopies performed outside the authors' institution, or whose colonoscopies and clinical assessments were undertaken more than one month apart were excluded. The PGA was used to determine disease activity in patients before colonoscopy. The Ulcerative Colitis Endoscopic Index of Severity, a validated scoring system to rate endoscopic disease severity in ulcerative colitis, was adapted. RESULTS: A total of 154 patients (mean [± SD] age 44 ± 15.7 years) with UC were identified including 82 (53%) men. Mean hemoglobin level was 139 g/L, mean platelet level was 296×10(9)/L, mean ferritin level was 102 μg/L, mean C-reactive protein level was 10 mg/L and mean albumin level was 40 g/L. Using endoscopy as the 'gold standard' for assessing UC activity (moderate-severe), abnormalities in laboratory parameters and PGA were both highly specific but not sensitive for identifying individuals with at least moderately active endoscopic disease. The PGA had higher positive and negative predictive values than the laboratory parameters. CONCLUSION: Neither blood tests nor PGA could replace endoscopy for assessing mucosal healing. When patients experienced active symptoms and abnormal serum markers, they were highly likely to have abnormal endoscopy. However, inactive symptoms or normal laboratory values did not preclude having active endoscopic disease.
BACKGROUND: Mucosal healing has been proposed as the therapeutic end point in the treatment of patients with ulcerative colitis (UC). OBJECTIVE: To investigate the relationship between physician global assessment (PGA) and laboratory blood tests (complete blood count, ferritin, C-reactive protein, albumin) and endoscopic findings in UC to determine whether they could be adequate surrogates for endoscopy. METHODS: A retrospective chart review of patients known to have UC from July 2008 to November 2012 was performed at the Health Sciences Centre, Winnipeg, Manitoba. Patients included individuals with UC who underwent colonoscopy within one month of clinic assessment. Blood tests were standard at the time of colonoscopy. Patients presenting through the emergency department, those with colonoscopies performed outside the authors' institution, or whose colonoscopies and clinical assessments were undertaken more than one month apart were excluded. The PGA was used to determine disease activity in patients before colonoscopy. The Ulcerative Colitis Endoscopic Index of Severity, a validated scoring system to rate endoscopic disease severity in ulcerative colitis, was adapted. RESULTS: A total of 154 patients (mean [± SD] age 44 ± 15.7 years) with UC were identified including 82 (53%) men. Mean hemoglobin level was 139 g/L, mean platelet level was 296×10(9)/L, mean ferritin level was 102 μg/L, mean C-reactive protein level was 10 mg/L and mean albumin level was 40 g/L. Using endoscopy as the 'gold standard' for assessing UC activity (moderate-severe), abnormalities in laboratory parameters and PGA were both highly specific but not sensitive for identifying individuals with at least moderately active endoscopic disease. The PGA had higher positive and negative predictive values than the laboratory parameters. CONCLUSION: Neither blood tests nor PGA could replace endoscopy for assessing mucosal healing. When patients experienced active symptoms and abnormal serum markers, they were highly likely to have abnormal endoscopy. However, inactive symptoms or normal laboratory values did not preclude having active endoscopic disease.
Authors: E F Stange; S P L Travis; S Vermeire; W Reinisch; K Geboes; A Barakauskiene; R Feakins; J F Fléjou; H Herfarth; D W Hommes; L Kupcinskas; P L Lakatos; G J Mantzaris; S Schreiber; V Villanacci; B F Warren Journal: J Crohns Colitis Date: 2008-01-18 Impact factor: 9.071
Authors: Brian G Feagan; Gordon R Greenberg; Gary Wild; Richard N Fedorak; Pierre Paré; John W D McDonald; Rejean Dubé; Albert Cohen; A Hillary Steinhart; Steven Landau; Rasha A Aguzzi; Irving H Fox; Margaret K Vandervoort Journal: N Engl J Med Date: 2005-06-16 Impact factor: 91.245
Authors: Geert D'Haens; William J Sandborn; Brian G Feagan; Karel Geboes; Stephen B Hanauer; E Jan Irvine; Marc Lémann; Philippe Marteau; Paul Rutgeerts; Jurgen Schölmerich; Lloyd R Sutherland Journal: Gastroenterology Date: 2006-12-20 Impact factor: 22.682
Authors: Christopher Ma; Jenny Jeyarajah; Leonardo Guizzetti; Claire E Parker; Siddharth Singh; Parambir S Dulai; Geert R D'Haens; William J Sandborn; Brian G Feagan; Vipul Jairath Journal: Clin Gastroenterol Hepatol Date: 2020-12-03 Impact factor: 11.382
Authors: Samuel N Adler; Yago González Lama; Virginia Matallana Royo; Cristina Suárez Ferrer; Avraham Schwartz; Ariella Bar-Gil Shitrit Journal: Endosc Int Open Date: 2019-10-01
Authors: Raja Atreya; Stuart Bloom; Franco Scaldaferri; Viviana Gerardi; Charlotte Admyre; Åsa Karlsson; Thomas Knittel; Jan Kowalski; Milan Lukas; Robert Löfberg; Stephane Nancey; Robert Petryka; Grazyna Rydzewska; Robert Schnabel; Ursula Seidler; Markus F Neurath; Christopher Hawkey Journal: J Crohns Colitis Date: 2016-05-20 Impact factor: 9.071