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Assessment of Disease Activity in Ulcerative Colitis

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Medical Therapy of Ulcerative Colitis

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Abstract

Management of ulcerative colitis (UC) is guided by the anatomical distribution of disease, severity of symptoms, response to medical therapy and ability of the patient to tolerate treatment. In its most severe form, acute ulcerative colitis can carry major morbidity and can be fatal. Disease severity indices help guide clinical decisions regarding appropriate initial treatment and are particularly helpful for patients who fail to show adequate response to first-line therapy but are also essential for evaluating therapeutic response and defining outcomes in clinical trials (D’Haens et al., Gastroenterology 132:763–786, 2007). Indeed, severity indices were all developed for use in clinical trials, although almost none have been formally validated and none have had responsiveness defined in clinical practice.

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References

  1. D’Haens G, Sandborn WJ, Feagan BG, et al. A review of activity indices and efficacy end points for clinical trials of medical therapy in adults with ulcerative colitis. Gastroenterology. 2007;132:763–86.

    Article  PubMed  Google Scholar 

  2. Turner D, Otley AR, Mack D, et al. Development, validation, and evaluation of a pediatric ulcerative colitis activity index: a prospective multicenter study. Gastroenterology. 2007;133:423–32.

    Article  PubMed  Google Scholar 

  3. Travis SPL, Schnell D, Krzeski P, et al. Development of an ulcerative colitis endoscopic index of severity (UCEIS). Gut. 2012;61:535–42.

    Google Scholar 

  4. Geboes K, Riddell R, Öst A, Jensfelt B, Persson T, Löfberg R. A reproducible grading scale for histological assessment of inflammation in ulcerative colitis. Gut. 2000;47:404–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Irvine EJ, Feagan B, Rochon J, et al. Quality of life: a valid and reliable measure of therapeutic efficacy in the treatment of inflammatory bowel disease. Canadian Crohn’s Relapse Prevention Trial Study Group. Gastroenterology. 1994;106:287–96.

    CAS  PubMed  Google Scholar 

  6. Travis SPL, Higgins PDR, Orchard T, et al. Defining remission in ulcerative colitis. Aliment Pharmacol Ther. 2011;34:113–24.

    Article  CAS  PubMed  Google Scholar 

  7. Truelove SC, Richards WC. Biopsy studies in ulcerative colitis. Br Med J. 1956;1:1315–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Wright JG, Feinstein AR. A comparative contrast of clinimetric and psychometric methods for constructing indexes and rating scales. J Clin Epidemiol. 1992;45:1201–18.

    Article  CAS  PubMed  Google Scholar 

  9. Marx RG, Bombardier C, Hogg-Johnson S, Wright JG. Clinimetric and psychometric strategies for development of a health measurement scale. J Clin Epidemiol. 1999;52:105–11.

    Article  CAS  PubMed  Google Scholar 

  10. Noble A, Turner D. Clinical outcomes in pediatric inflammatory bowel disease. In: Mamula P, Markowitz J, Baldassano R, editors. Pediatric inflammatory bowel disease, vol. 1. Berlin: Springer; 2008. p. 744.

    Google Scholar 

  11. Lohr KN. Assessing health status and quality-of-life instruments: attributes and review criteria. Qual Life Res. 2002;11:193–205.

    Article  PubMed  Google Scholar 

  12. Yoshida EM. The Crohn’s Disease Activity Index, its derivatives and the inflammatory bowel disease questionnaire: a review of instruments to assess Crohn’s disease. Can J Gastroenterol. 1999;13:65–73.

    CAS  PubMed  Google Scholar 

  13. Sandborn WJ, Sands BE, Wolf DC, et al. Repifermin (keratinocyte growth factor-2) for the treatment of active ulcerative colitis: a randomized, double-blind, placebo-controlled, dose-escalation trial. Aliment Pharmacol Ther. 2003;17:1355–64.

    Article  CAS  PubMed  Google Scholar 

  14. Walmsley RS, Ayres RCS, Pounder RE, Allan RN. A simple clinical colitis activity index. Gut. 1998;43:29–32.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Lichtiger S, Present D. Preliminary report: cyclosporin in treatment of severe active ulcerative colitis. Lancet. 1990;336:16–9.

    Article  CAS  PubMed  Google Scholar 

  16. Feagan BG, Greenberg GR, Wild G, et al. Treatment of ulcerative colitis with a humanized antibody to the α4β7 integrin. N Engl J Med. 2005;352:2499–507.

    Article  CAS  PubMed  Google Scholar 

  17. Beattie RM, Nicholls SW, Domizio P, Williams CB, Walker-Smith JA. Endoscopic assessment of the colonic response to corticosteroids in children with ulcerative colitis. J Pediatr Gastroenterol Nutr. 1996;22:373–9.

    Article  CAS  PubMed  Google Scholar 

  18. Schroeder KW, Tremaine WJ, Ilstrup DM. Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. N Engl J Med. 1987;317:1625–9.

    Article  CAS  PubMed  Google Scholar 

  19. Sutherland LR, Martin F, Greer S, et al. 5-Aminosalicylic acid enema in the treatment of distal ulcerative colitis, proctosigmoiditis, and proctitis. Gastroenterology. 1987;92:1894–8.

    CAS  PubMed  Google Scholar 

  20. Powell-Tuck J, Bown RL, Lennard-Jones JE. A comparison of oral prednisolone given as single or multiple daily doses for active proctocolitis. Scand J Gastroenterol. 1978;13:833–7.

    Article  CAS  PubMed  Google Scholar 

  21. Rachmilewitz D. Coated mesalazine (5-aminosalicylic acid) versus sulphasalazine in the treatment of active ulcerative colitis: a randomised trial. Br Med J. 1989;298:82–6.

    Article  CAS  Google Scholar 

  22. Seo M, Okada M, Yao T, et al. An index of disease activity in patients with ulcerative colitis. Am J Gastroenterol. 1992;87:971–6.

    CAS  PubMed  Google Scholar 

  23. Truelove S, Witts LJ. Cortisone in ulcerative colitis. Final report on a therapeutic trial. Br Med J. 1955;2:1041–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Silverberg MS, Satsangi J, Ahmad T, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a working party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol. 2005;19(Suppl A):5–36.

    Google Scholar 

  25. Baron JH, Connell AM, L-J JE. Variation between observers in describing mucosal appearances in proctocolitis. Br Med J. 1964;1:89–92.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Naganuma M, Ichikawa H, Inoue N, et al. Novel endoscopic activity index is useful for choosing treatment in severe active ulcerative colitis patients. Gastroenterology. 2010;45:936–43.

    Article  Google Scholar 

  27. Riley SA, Mani V, Goodman MJ, Dutt S, Herd ME. Microscopic activity in ulcerative colitis: what does it mean? Gut. 1991;32:174–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Saverymuttu SH, Camilleri M, Rees H, Lavender JP, Hodgson HJF, Chadwick VS. Indium 111-granulocyte scanning in the assessment of disease extent and disease activity in inflammatory bowel disease: A comparison with colonoscopy, histology, and fecal indium 111-granulocyte excretion. Gastroenterology. 1986;90:1121–8.

    CAS  PubMed  Google Scholar 

  29. Irvine EJ, Zhou Q, Thompson AK. The Short Inflammatory Bowel Disease Questionnaire: a quality of life instrument for community physicians managing inflammatory bowel disease. CCRPT Investigators. Canadian Crohn’s Relapse Prevention Trial. Am J Gastroenterol. 1996;91:1571–8.

    CAS  PubMed  Google Scholar 

  30. W-y C, Garratt AM, Russell IT, Williams JG. The UK IBDQ – a British version of the inflammatory bowel disease questionnaire: development and validation. J Clin Epidemiol. 2000;53:297–306.

    Article  Google Scholar 

  31. Drossman D, Leserman J, Li Z, Mitchell C, Zagami E, Patrick D. The rating form of IBD patient concerns: a new measure of health status. Psychosom Med. 1991;53:701–12.

    Article  CAS  PubMed  Google Scholar 

  32. Travis S, Farrant JM, Ricketts C, et al. Predicting outcome in severe ulcerative colitis. Gut. 1996;38:905–10.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  33. Turner D, Seow CH, Greenberg GR, Griffiths AM, Silverberg MS, Steinhart AH. A systematic prospective comparison of noninvasive disease activity indices in ulcerative colitis. Clin Gastroenterol Hepatol. 2009;7:1081–8.

    Article  PubMed  Google Scholar 

  34. Rutgeerts P, Sandborn WJ, Feagan BG, et al. Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2005;353:2462–76.

    Article  CAS  PubMed  Google Scholar 

  35. Harvey RF, Bradshaw JM. A simple index of Crohn’s disease activity. Lancet. 1980;315:514.

    Article  Google Scholar 

  36. Plevy S, Salzberg B, Van Assche G, et al. A phase I study of visilizumab, a humanized anti-CD3 monoclonal antibody, in severe steroid-refractory ulcerative colitis. Gastroenterology. 2007;133:1414–22.

    Article  CAS  PubMed  Google Scholar 

  37. Sandborn WJ, Colombel JF, Frankel M, et al. Anti-CD3 antibody visilizumab is not effective in patients with intravenous corticosteroid-refractory ulcerative colitis. Gut. 2010;59:1485–92.

    Article  CAS  PubMed  Google Scholar 

  38. Travis S. Does it all ADA up? Adalimumab for ulcerative colitis. Gut. 2011;60:741–2.

    Article  PubMed  Google Scholar 

  39. Walsh AJ, Brain AOS, Keshav S, et al. How variable is the Mayo score between observers and might this affect trial recruitment or outcome? J Crohns Colitis. 2009;3:S71.

    Article  Google Scholar 

  40. Hanauer SB, Sandborn WJ, Kornbluth A, et al. Delayed-release oral mesalamine at 4.8 g//day (800 mg tablet) for the treatment of moderately active ulcerative colitis: the ASCEND II trial. Am J Gastroenterol. 2005;100:2478–85.

    Article  CAS  PubMed  Google Scholar 

  41. Hanauer SB, Sandborn WJ, Dallaire C, et al. Delayed-release oral mesalamine 4.8 g/day (800 mg tablets) compared to 2.4 g/day (400 mg tablets) for the treatment of mildly to moderately active ulcerative colitis: the ASCEND I trial. Can J Gastroenterol. 2007;21:827–34.

    CAS  PubMed Central  PubMed  Google Scholar 

  42. Katz S, Higgins P, Eusebio R, Yacyshyn B. Different definitions of remission for ulcerative colitis result in large variations of clinical outcome scores. Gastroenterology. 2006;130 Suppl 2:A-482.

    Google Scholar 

  43. Marteau P, Probert CS, Lindgren S, et al. Combined oral and enema treatment with Pentasa (mesalazine) is superior to oral therapy alone in patients with extensive mild/moderate active ulcerative colitis: a randomised, double blind, placebo controlled study. Gut. 2005;54:960–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  44. Kamm MA, Sandborn WJ, Gassull M, et al. Once-daily, high-concentration MMX mesalamine in active ulcerative colitis. Gastroenterology. 2007;132:66–75.

    Article  CAS  PubMed  Google Scholar 

  45. Higgins PD, Schwartz M, Mapili J, Krokos I, Leung J, Zimmermann EM. Patient defined dichotomous end points for remission and clinical improvement in ulcerative colitis. Gut. 2005;54:782–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  46. Kruis W, Kiudelis G, Rácz I, et al. Once daily versus three times daily mesalazine granules in active ulcerative colitis: a double-blind, double-dummy, randomised, non-inferiority trial. Gut. 2009;58:233–40.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  47. Seo M, Okada M, Yao T, et al. Evaluation of disease activity in patients with moderately active ulcerative colitis: comparisons between a new activity index and Truelove and Witts’ classification. Am J Gastroenterol. 1995;90:1759–63.

    CAS  PubMed  Google Scholar 

  48. Järnerot G, Hertervig E, Friis-Liby I, et al. Infliximab as rescue therapy in severe to moderately severe ulcerative colitis: a randomized, placebo-controlled study. Gastroenterology. 2005;128:1805–11.

    Article  PubMed  Google Scholar 

  49. Turner D, Walsh CM, Steinhart AH, Griffiths AM. Response to corticosteroids in severe ulcerative colitis: a systematic review of the literature and a meta-regression. Clin Gastroenterol Hepatol. 2007;5:103–10.

    Article  CAS  PubMed  Google Scholar 

  50. Dinesen LC, Walsh AJ, Protic MN, et al. The pattern and outcome of acute severe colitis. J Crohns Colitis. 2010;4(4):431–7.

    Article  PubMed  Google Scholar 

  51. Brown SR, Haboubi N, Hampton J, George B, Travis SPL. The management of acute severe colitis: ACPGBI position statement. Colorectal Dis. 2008;10:8–29.

    Article  PubMed  Google Scholar 

  52. Kornbluth A, Sachar DB. Ulcerative colitis practice guidelines in adults: American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol. 2010;105:501–23.

    Article  PubMed  Google Scholar 

  53. Van Assche G, Dignass A and Travis SPL (steering group) for the European Crohn’s and Colitis Organisation (ECCO). The second European evidence-based Consensus on the diagnosis and management of ulcerative colitis. J Crohns Colitis. 2013;7(1):1–33.

    Google Scholar 

  54. Powell-Tuck J, Day DW, Buckell NA, Wadsworth J, Lennard-Jones JE. Correlations between defined sigmoidoscopic appearances and other measures of disease activity in ulcerative colitis. Dig Dis Sci. 1982;27:533–7.

    Article  CAS  PubMed  Google Scholar 

  55. Rutegard I, Ahsgren L, Stenling R, Nilsson T. A simple index for assessment of disease activity in patients with ulcerative colitis. Hepatogastroenterology. 1990;37 Suppl 2:110–2.

    PubMed  Google Scholar 

  56. Colombel JF, Rutgeerts P, Reinisch W, et al. Early mucosal healing with infliximab is associated with improved long-term clinical outcomes in ulcerative colitis. Gastroenterology. 2011;141:1194–201.

    Article  CAS  PubMed  Google Scholar 

  57. Osada T, Ohkusa T, Yokoyama T, et al. Comparison of several activity indices for the evaluation of endoscopic activity in UC: inter- and intraobserver consistency. Inflamm Bowel Dis. 2010;16:192–7.

    Article  PubMed  Google Scholar 

  58. Flavell Matts SG. The value of rectal biopsies in the diagnosis of ulcerative colitis. QJM. 1961;30:393–407.

    Google Scholar 

  59. Blackstone MO. Inflammatory bowel disease. In: Blackstone MO, editor. Endoscopic interpretation. New York: Raven; 1984. p. 464–94.

    Google Scholar 

  60. Kamm MA, Lichtenstein GR, Sandborn WJ, et al. Randomised trial of once or twice daily MMX mesalazine for maintenance of remission in ulcerative colitis. Gut. 2008;57:893–902.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  61. Travis SPL, Schnell D, Krzeski P, et al. Reliability and initial validation of the Ulcerative Colitis Endoscopic Index of Severity (UCEIS). Gastroenterology. 2013;145:987–95.

    Google Scholar 

  62. Thia KT, Loftus EV, Pardi DS, et al. Measurement of disease activity in ulcerative colitis: interobserver agreement and predictors of severity. Inflamm Bowel Dis. 2011;17:1257–64.

    Article  PubMed  Google Scholar 

  63. Wright R, Truelove S. Serial rectal biopsy in ulcerative colitis during the course of a controlled therapeutic trial of various diets. Dig Dis Sci. 1966;11:847–57.

    Article  CAS  Google Scholar 

  64. Burger DC, Thomas SJ, Walsh AJ, et al. Depth of remission may not predict outcome of UC over 2 years. Gut. 2011;60 Suppl 1:A133.

    Article  Google Scholar 

  65. Sandborn WJ, Moro L, Ballard ED, Travis SPL. Induction of remission of mild to moderately active ulcerative colitis with budesonide-MMX 9 mg: a multicentre, randomised, double-blind placebo-controlled trial in North America and India. Gut. 2011 (UEGW presentation).

    Google Scholar 

  66. Stange EF, Travis SPL, Vermeire S, et al. European evidence-based consensus on the diagnosis and management of ulcerative colitis: Definitions and diagnosis. J Crohns Colitis. 2008;2:1–23.

    Article  CAS  PubMed  Google Scholar 

  67. Hoivik ML, Bernklev T, Moum B. Need for standardization in population-based quality of life studies: a review of the current literature. Inflamm Bowel Dis. 2010;16:525–36.

    Article  PubMed  Google Scholar 

  68. Irvine EJ. Quality of life of patients with ulcerative colitis: past, present, and future. Inflamm Bowel Dis. 2008;14:554–65.

    Article  PubMed  Google Scholar 

  69. Ware JEJ, Sherbourne CD. The MOS 36-ltem short-form health survey (SF-36): I conceptual framework and item selection. Medical Care. 1992;30:473–83.

    Article  PubMed  Google Scholar 

  70. The EQ-5D quality of life questionnaire. http://www.euroqol.org/eq-5d/what-is-eq-5d.html. Accessed 16 Jan 2012.

  71. The CONSTRUCT Trial. http://www.construct.swansea.ac.uk. Accessed 16 Jan 2012.

  72. Levenstein S, Li Z, Almer S, et al. Cross-cultural variation in disease-related concerns among patients with inflammatory bowel disease. Am J Gastroenterol. 2001;96:1822–30.

    Article  CAS  PubMed  Google Scholar 

  73. Travis S, Satsangi J, Lémann M. Predicting the need for colectomy in severe ulcerative colitis: a critical appraisal of clinical parameters and currently available biomarkers. Gut. 2011 2011;60:3-9.

    Google Scholar 

  74. Turner D, Griffiths AM, Mack D, et al. Assessing disease activity in ulcerative colitis: patients or their physicians? Inflamm Bowel Dis. 2010;16:651–6.

    Article  PubMed  Google Scholar 

  75. Waljee AK, Joyce JC, Wren PA, Khan TM, Higgins PD. Patient reported symptoms during an ulcerative colitis flare: a Qualitative Focus Group Study. Eur J Gastroenterol Hepatol. 2009;21:558–64.

    Article  PubMed Central  PubMed  Google Scholar 

  76. Umanskiy K, Fichera A. Health related quality of life in inflammatory bowel disease: the impact of surgical therapy. World J Gastroenterol. 2010;16:5024–34.

    Article  PubMed Central  PubMed  Google Scholar 

  77. Turner D, Mack D, Leleiko N, et al. Severe pediatric ulcerative colitis: a prospective multicenter study of outcomes and predictors of response. Gastroenterology. 2010;138:2282–91.

    Article  CAS  PubMed  Google Scholar 

  78. Lennard-Jones JE, Ritchie JK, Hilder W, Spicer CC. Assessment of severity in colitis: a preliminary study. Gut. 1975;16:579–84.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  79. Turner D, Walsh CM, Benchimol EI, et al. Severe paediatric ulcerative colitis: incidence, outcomes and optimal timing for second-line therapy. Gut. 2008;57:331–8.

    Article  CAS  PubMed  Google Scholar 

  80. Ho GT, Mowat C, Goddard CJR, et al. Predicting the outcome of severe ulcerative colitis: development of a novel risk score to aid early selection of patients for second-line medical therapy or surgery. Aliment Pharmacol Ther. 2004;19:1079–87.

    Article  CAS  PubMed  Google Scholar 

  81. Benazzato L, D’Incà R, Grigoletto F, et al. Prognosis of severe attacks in ulcerative colitis: effect of intensive medical treatment. Dig Liver Dis. 2004;36:461–6.

    Article  CAS  PubMed  Google Scholar 

  82. Colombel JF, Rutgeerts P, Reinisch W, et al. Early mucosal healing With infliximab is associated with improved long-term clinical outcomes in ulcerative colitis. Gastroenterology. 2011;141:1194–201.

    Article  CAS  PubMed  Google Scholar 

  83. Carbonnel F, Lavergne A, Lémann M, et al. Colonoscopy of acute colitis. Dig Dis Sci. 1994;39:1550–7.

    Article  CAS  PubMed  Google Scholar 

  84. Su C, Lewis JD, Goldberg B, Brensinger C, Lichtenstein GR. A meta-analysis of the placebo rates of remission and response in clinical trials of active ulcerative colitis. Gastroenterology. 2007;132:516–26.

    Article  PubMed  Google Scholar 

  85. Sinha A, Nightingale JMD, West KP, Berlanga-Acosta J, Playford RJ. Epidermal growth factor enemas with oral mesalamine for mild-to-moderate left-sided ulcerative colitis or proctitis. N Engl J Med. 2003;349:350–7.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, OX3 9DU, UK

    Rebecca Palmer M.R.C.P. & Simon Travis D.Phil., F.R.C.P.

  2. Gastroenterology Unit, St. Vincent’s Hospital, Sydney, NSW, Australia

    Alissa Walsh F.R.A.C.P.

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  1. Rebecca Palmer M.R.C.P.
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Correspondence to Simon Travis D.Phil., F.R.C.P. .

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  1. Gastroenterology Division, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

    Gary R. Lichtenstein

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Palmer, R., Walsh, A., Travis, S. (2014). Assessment of Disease Activity in Ulcerative Colitis. In: Lichtenstein, G. (eds) Medical Therapy of Ulcerative Colitis. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1677-1_32

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