Novel endoscopic activity index is useful for choosing treatment in severe active ulcerative colitis patients

Makoto Naganuma, Hitoshi Ichikawa, Nagamu Inoue, Taku Kobayashi, Susumu Okamoto, Tadakazu Hisamatsu, Takanori Kanai, Haruhiko Ogata, Yasushi Iwao, Toshifumi Hibi

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Aim: Clinical symptoms are the most important factors used by physicians to evaluate the severity and extent of ulcerative colitis (UC). In this context, colonoscopy is also a useful diagnostic tool. We have recently developed an endoscopic activity index (EAI) to assess the severity of UC. Here, we assess the correlations among the EAI, other endoscopic indices, and clinical scores. The usefulness of the EAI for choosing treatment options, such as intravenous corticosteroid or cyclosporine A (CsA), in severe UC patients was also evaluated. Methods: Clinical symptoms and endoscopic finding were evaluated in 396 patients with UC (454 colonoscopies). The EAI was scored using the following six items: ulcer size, ulcer depth, redness, bleeding, edema, and mucus exudates. The patients were also scored using Matts' grade, Rachmilewitz's endoscopic index, and the Lichtiger index. Results: Our results showed that (1) the EAI scores were closely correlated with those of the Lichtiger index, Matts' grade, and Rachmilewitz's endoscopic index; (2) the EAI scores significantly decreased in patients who responded to treatment, while Matts' grade did not change in some responders treated with intravenous CsA and steroid; (3) patients with a higher EAI (14-16) tended to be refractory to corticosteroid therapy (responders 19%) compared to CsA (77%), while steroid treatment was effective in 58% of patients with EAI scores of 11-13. Conclusions: The EAI is equivalent to other endoscopic indices and relatively more useful in choosing a treatment for patients with severe UC.

Original languageEnglish
Pages (from-to)936-943
Number of pages8
JournalJournal of Gastroenterology
Volume45
Issue number9
DOIs
Publication statusPublished - 2010 Sep

Fingerprint

Ulcerative Colitis
Cyclosporine
Colonoscopy
Therapeutics
Ulcer
Adrenal Cortex Hormones
Steroids
Exudates and Transudates
Mucus
Edema
Hemorrhage
Physicians

Keywords

  • Cyclosporine A
  • Endoscopic activity index
  • Ulcerative colitis

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Novel endoscopic activity index is useful for choosing treatment in severe active ulcerative colitis patients. / Naganuma, Makoto; Ichikawa, Hitoshi; Inoue, Nagamu; Kobayashi, Taku; Okamoto, Susumu; Hisamatsu, Tadakazu; Kanai, Takanori; Ogata, Haruhiko; Iwao, Yasushi; Hibi, Toshifumi.

In: Journal of Gastroenterology, Vol. 45, No. 9, 09.2010, p. 936-943.

Research output: Contribution to journalArticle

@article{8b77f07718304f1f9189604e72ca703a,
title = "Novel endoscopic activity index is useful for choosing treatment in severe active ulcerative colitis patients",
abstract = "Aim: Clinical symptoms are the most important factors used by physicians to evaluate the severity and extent of ulcerative colitis (UC). In this context, colonoscopy is also a useful diagnostic tool. We have recently developed an endoscopic activity index (EAI) to assess the severity of UC. Here, we assess the correlations among the EAI, other endoscopic indices, and clinical scores. The usefulness of the EAI for choosing treatment options, such as intravenous corticosteroid or cyclosporine A (CsA), in severe UC patients was also evaluated. Methods: Clinical symptoms and endoscopic finding were evaluated in 396 patients with UC (454 colonoscopies). The EAI was scored using the following six items: ulcer size, ulcer depth, redness, bleeding, edema, and mucus exudates. The patients were also scored using Matts' grade, Rachmilewitz's endoscopic index, and the Lichtiger index. Results: Our results showed that (1) the EAI scores were closely correlated with those of the Lichtiger index, Matts' grade, and Rachmilewitz's endoscopic index; (2) the EAI scores significantly decreased in patients who responded to treatment, while Matts' grade did not change in some responders treated with intravenous CsA and steroid; (3) patients with a higher EAI (14-16) tended to be refractory to corticosteroid therapy (responders 19{\%}) compared to CsA (77{\%}), while steroid treatment was effective in 58{\%} of patients with EAI scores of 11-13. Conclusions: The EAI is equivalent to other endoscopic indices and relatively more useful in choosing a treatment for patients with severe UC.",
keywords = "Cyclosporine A, Endoscopic activity index, Ulcerative colitis",
author = "Makoto Naganuma and Hitoshi Ichikawa and Nagamu Inoue and Taku Kobayashi and Susumu Okamoto and Tadakazu Hisamatsu and Takanori Kanai and Haruhiko Ogata and Yasushi Iwao and Toshifumi Hibi",
year = "2010",
month = "9",
doi = "10.1007/s00535-010-0244-2",
language = "English",
volume = "45",
pages = "936--943",
journal = "Journal of Gastroenterology",
issn = "0944-1174",
publisher = "Springer Japan",
number = "9",

}

TY - JOUR

T1 - Novel endoscopic activity index is useful for choosing treatment in severe active ulcerative colitis patients

AU - Naganuma, Makoto

AU - Ichikawa, Hitoshi

AU - Inoue, Nagamu

AU - Kobayashi, Taku

AU - Okamoto, Susumu

AU - Hisamatsu, Tadakazu

AU - Kanai, Takanori

AU - Ogata, Haruhiko

AU - Iwao, Yasushi

AU - Hibi, Toshifumi

PY - 2010/9

Y1 - 2010/9

N2 - Aim: Clinical symptoms are the most important factors used by physicians to evaluate the severity and extent of ulcerative colitis (UC). In this context, colonoscopy is also a useful diagnostic tool. We have recently developed an endoscopic activity index (EAI) to assess the severity of UC. Here, we assess the correlations among the EAI, other endoscopic indices, and clinical scores. The usefulness of the EAI for choosing treatment options, such as intravenous corticosteroid or cyclosporine A (CsA), in severe UC patients was also evaluated. Methods: Clinical symptoms and endoscopic finding were evaluated in 396 patients with UC (454 colonoscopies). The EAI was scored using the following six items: ulcer size, ulcer depth, redness, bleeding, edema, and mucus exudates. The patients were also scored using Matts' grade, Rachmilewitz's endoscopic index, and the Lichtiger index. Results: Our results showed that (1) the EAI scores were closely correlated with those of the Lichtiger index, Matts' grade, and Rachmilewitz's endoscopic index; (2) the EAI scores significantly decreased in patients who responded to treatment, while Matts' grade did not change in some responders treated with intravenous CsA and steroid; (3) patients with a higher EAI (14-16) tended to be refractory to corticosteroid therapy (responders 19%) compared to CsA (77%), while steroid treatment was effective in 58% of patients with EAI scores of 11-13. Conclusions: The EAI is equivalent to other endoscopic indices and relatively more useful in choosing a treatment for patients with severe UC.

AB - Aim: Clinical symptoms are the most important factors used by physicians to evaluate the severity and extent of ulcerative colitis (UC). In this context, colonoscopy is also a useful diagnostic tool. We have recently developed an endoscopic activity index (EAI) to assess the severity of UC. Here, we assess the correlations among the EAI, other endoscopic indices, and clinical scores. The usefulness of the EAI for choosing treatment options, such as intravenous corticosteroid or cyclosporine A (CsA), in severe UC patients was also evaluated. Methods: Clinical symptoms and endoscopic finding were evaluated in 396 patients with UC (454 colonoscopies). The EAI was scored using the following six items: ulcer size, ulcer depth, redness, bleeding, edema, and mucus exudates. The patients were also scored using Matts' grade, Rachmilewitz's endoscopic index, and the Lichtiger index. Results: Our results showed that (1) the EAI scores were closely correlated with those of the Lichtiger index, Matts' grade, and Rachmilewitz's endoscopic index; (2) the EAI scores significantly decreased in patients who responded to treatment, while Matts' grade did not change in some responders treated with intravenous CsA and steroid; (3) patients with a higher EAI (14-16) tended to be refractory to corticosteroid therapy (responders 19%) compared to CsA (77%), while steroid treatment was effective in 58% of patients with EAI scores of 11-13. Conclusions: The EAI is equivalent to other endoscopic indices and relatively more useful in choosing a treatment for patients with severe UC.

KW - Cyclosporine A

KW - Endoscopic activity index

KW - Ulcerative colitis

UR - http://www.scopus.com/inward/record.url?scp=77956895195&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77956895195&partnerID=8YFLogxK

U2 - 10.1007/s00535-010-0244-2

DO - 10.1007/s00535-010-0244-2

M3 - Article

C2 - 20401498

AN - SCOPUS:77956895195

VL - 45

SP - 936

EP - 943

JO - Journal of Gastroenterology

JF - Journal of Gastroenterology

SN - 0944-1174

IS - 9

ER -