A Comparative Analysis of Clinical Symptoms and Modified Pouchitis Disease Activity Index Among Endoscopic Phenotypes of the J Pouch in Patients With Inflammatory Bowel Disease.

IF 1.8 Q3 GASTROENTEROLOGY & HEPATOLOGY Crohn's & Colitis 360 Pub Date : 2024-08-02 eCollection Date: 2024-07-01 DOI:10.1093/crocol/otae045
Shintaro Akiyama, Nathaniel A Cohen, Jacob E Ollech, Cindy Traboulsi, Tina Rodriguez, Victoria Rai, Laura R Glick, Yangtian Yi, Joseph Runde, Russell D Cohen, Kinga B Skowron, Roger D Hurst, Konstantin Umanskiy, Benjamin D Shogan, Neil H Hyman, Michele A Rubin, Sushila R Dalal, Atsushi Sakuraba, Joel Pekow, Eugene B Chang, David T Rubin
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引用次数: 0

Abstract

Background: The modified pouchitis disease activity index (mPDAI) based on clinical symptoms and endoscopic findings is used to diagnose pouchitis, but validated instruments to monitor pouchitis are still lacking. We recently established an endoscopic classification that described 7 endoscopic phenotypes with different outcomes. We assessed symptoms and compared mPDAIs among phenotypes in inflammatory bowel disease (IBD).

Methods: We retrospectively reviewed pouchoscopies and classified them into 7 main phenotypes: normal (n = 25), afferent limb (AL) involvement (n = 4), inlet involvement (n = 14), diffuse (n = 7), focal inflammation of the pouch body (n = 25), cuffitis (n = 18), and pouch-related fistulas (n = 10) with a single phenotype were included. Complete-case analysis was conducted.

Results: One hundred and three IBD patients were included. The median mPDAI was 0 (IQR 0-1.0) in patients with a normal pouch. Among inflammatory phenotypes, the highest median mPDAI was 4.0 (IQR 2.25-4.75) in cuffitis, followed by 3.0 (IQR 2.5-4.0) in diffuse inflammation, 2.5 (IQR 1.25-4.0) in inlet involvement, 2.5 (IQR 2.0-3.5) in AL involvement, 2.0 (IQR 1.0-3.0) in focal inflammation, and 1.0 (IQR 0.25-2.0) in the fistula phenotype. Perianal symptoms were frequently observed in pouch-related fistulas (8/10, 80%) and cuffitis (13/15, 87%). Among patients with cuffitis, all had incomplete emptying (6/6, 100%).

Conclusions: We correlated the mPDAI with the endoscopic phenotypes and described the limited utility of symptoms in distinguishing between inflammatory phenotypes. Further studies are warranted to understand which symptoms should be monitored for each phenotype and whether mPDAI can be minimized after pouch normalization.

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炎症性肠病患者 J 袋内镜下各型临床症状和改良袋炎疾病活动指数的比较分析。
背景:基于临床症状和内镜检查结果的改良型胃袋炎疾病活动指数(mPDAI)可用于诊断胃袋炎,但目前仍缺乏监测胃袋炎的有效工具。我们最近建立了一种内镜分类法,描述了具有不同结果的 7 种内镜表型。我们评估了炎症性肠病(IBD)的症状,并比较了不同表型的 mPDAIs:方法:我们回顾性地检查了肠袋镜检查,并将其分为 7 种主要表型:正常(25 例)、传入肢(AL)受累(4 例)、入口受累(14 例)、弥漫性(7 例)、肠袋体局灶性炎症(25 例)、袖套炎(18 例)和肠袋相关瘘管(10 例)。进行了完整病例分析:结果:共纳入 103 名 IBD 患者。正常瘘袋患者的 mPDAI 中位数为 0(IQR 0-1.0)。在炎症表型中,袖带炎的 mPDAI 中位数最高,为 4.0(IQR 2.25-4.75),其次是弥漫性炎症 3.0(IQR 2.5-4.0),入口受累 2.5(IQR 1.25-4.0),AL 受累 2.5(IQR 2.0-3.5),局灶性炎症 2.0(IQR 1.0-3.0),瘘管表型 1.0(IQR 0.25-2.0)。肛周症状常见于与肛袋相关的瘘管(8/10,80%)和袖带炎(13/15,87%)。在袖口炎患者中,所有患者都有排空不完全的症状(6/6,100%):结论:我们将 mPDAI 与内镜表型相关联,并描述了症状在区分炎症表型方面的有限作用。为了了解每种表型应监测哪些症状,以及在胃袋正常化后是否能将 mPDAI 降到最低,有必要进行进一步研究。
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来源期刊
Crohn's & Colitis 360
Crohn's & Colitis 360 Medicine-Gastroenterology
CiteScore
2.50
自引率
0.00%
发文量
41
审稿时长
12 weeks
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