Background and Aims

Treatment goals in Crohn’s disease (CD) have evolved to target mucosal healing. There is now a drive to determine if noninvasive measures can adequately identify the attainment and persistence of this goal. Currently, data describing the relationship between clinical indices and endoscopic appearance in pediatric CD are sparse. Our aim was to compare endoscopic severity with the weighted Pediatric Crohn’s Disease Activity Index (wPCDAI) in children with newly diagnosed CD.

Methods

All children aged ≤17 years newly diagnosed with CD enrolled in an inception cohort at sites of the Canadian Children Inflammatory Bowel Disease Network were eligible. Clinical disease activity at presentation was evaluated by the wPCDAI and conventional biochemical parameters. Severity of disease at ileocolonoscopy was assessed by the simple endoscopic score for CD (SES-CD), with segmental subscores noted. We evaluated the association of SES-CD and disease activity markers using the Pearson test of correlation, the Spearman rank coefficient, and linear regression models.

Results

Two hundred eighty patients from 11 centers were included in the analysis. The median wPCDAI score was 60 (interquartile range, 40-80; 53% severe). Median SES-CD was 16 (interquartile range 10-22; 51% severe). The wPCDAI correlated weakly with SES-CD (r = .39, P < .001). Examination of the individual components that contribute to the wPCDAI demonstrated weak correlation with the SES-CD for all items apart from stooling (moderate correlation, r = .50, P < .001). Routine blood tests did not correlate well with the SES-CD. In regression models, variation in clinical symptoms accounted for most of the variation in both the wPCDAI and SES-CD, with no additional benefit from routine blood tests.

Conclusions

In children with newly diagnosed CD, wPCDAI correlates poorly with endoscopic disease activity. As treatment paradigms evolve to target mucosal healing, clinical markers should not be used in isolation to determine disease activity.

中文翻译：

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新诊断为克罗恩病的儿童的临床疾病活动性和内窥镜检查严重程度相关性很差

背景和目标

克罗恩病（CD）的治疗目标已发展为靶向黏膜愈合。现在有一种驱动力来确定非侵入性措施是否可以充分确定该目标的实现和持久性。目前，描述儿童CD中临床指标与内镜外观之间关系的数据很少。我们的目的是将初诊CD患儿的内镜严重度与加权小儿克罗恩病活动指数（wPCDAI）进行比较。

方法

在加拿大儿童炎症性肠病网络站点的初始队列中入组的所有新诊断为CD的≤17岁儿童均符合条件。通过wPCDAI和常规生化参数评估临床表现。回肠结肠镜检查的疾病严重程度通过简单的内镜CD评分（SES-CD）进行评估，并记录分段评分。我们使用相关性的皮尔逊检验，斯皮尔曼等级系数和线性回归模型评估了SES-CD与疾病活动标记的关联。

结果

分析包括来自11个中心的280名患者。wPCDAI评分的中位数为60（四分位间距为40-80；严重度为53％）。SES-CD的中位数为16（四分位间距为10-22；严重度为51％）。wPCDAI与SES-CD的相关性较弱（r = .39，P  <.001）。对构成wPCDAI的各个成分的检查表明，除粪便外，所有物品与SES-CD的相关性均较弱（中等相关性，r = .50，P  <.001）。常规血液检查与SES-CD没有很好的相关性。在回归模型中，临床症状的变化是wPCDAI和SES-CD的大部分变化，常规血液检查没有其他好处。

结论

在患有新诊断的CD的儿童中，wPCDAI与内窥镜疾病活动的相关性很差。随着治疗范例发展为靶向粘膜愈合，不应孤立使用临床标志物来确定疾病的活动。