Document Detail


Are colonoscopy and bowel ultrasound useful for assessing response to short-term therapy and predicting disease outcome of moderate-to-severe forms of ulcerative colitis?: a prospective study.
MedLine Citation:
PMID:  19997096     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Mucosal healing has been proposed as an important sign of the efficacy of medical treatment of inflammatory bowel disease; however, direct evidence in ulcerative colitis (UC) is scarce. We evaluated the usefulness of colonoscopy and bowel ultrasound (US) as indexes of response to short-term therapy and as predictors of subsequent outcome in UC. METHODS: A total of 83 patients with moderate-to-severe UC were recruited; endoscopic and US severity was graded 0-3 at entry according to validated scores. Of the recruited patients, 74, who were clinically responsive to steroids, were followed up with repeated colonoscopy and bowel US at 3, 9, and 15 months from recruitment. Concordance between clinical, endoscopic, and US scores at various visits was determined by kappa statistics. Multiple unconditional logistic regression models were used to assess the predictivity of clinical, endoscopic, and US scores measured at 3 and 9 months on the development of endoscopic UC relapse within 15 months. RESULTS: A variable concordance was found over time between endoscopic and clinical score (weighted kappa between 0.38 and 0.95), with high and consistent concordance between endoscopic and US scores (weighted kappa between 0.76 and 0.90). On logistic regression analysis, moderate-to-severe endoscopic and US scores at 3 months were associated with a high risk of endoscopic activity at 15 months (odds ratio (OR): 5.2; 95% confidence interval (CI): 1.6-17.6 and OR: 9.1; 95% CI: 2.5-33.5, respectively). CONCLUSIONS: Bowel US may be used as a surrogate of colonoscopy in assessing the short-term response of severe forms of UC to therapy. Both US score and endoscopic score after 3 months of steroid therapy predict outcome of disease at 15 months.
Authors:
Fabrizio Parente; Mirko Molteni; Barbara Marino; Agostino Colli; Sandro Ardizzone; Salvatore Greco; Gianluca Sampietro; Diego Foschi; Silvano Gallus
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article     Date:  2009-12-08
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  105     ISSN:  1572-0241     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-06     Completed Date:  2010-06-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1150-7     Citation Subset:  IM    
Affiliation:
Gastrointestinal Unit, A. Manzoni Hospital, Lecco, Italy. f.parente@ospedale.lecco.it
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adrenal Cortex Hormones / therapeutic use
Adult
Cohort Studies
Colitis, Ulcerative / drug therapy,  pathology*,  ultrasonography*
Colonoscopy / methods*
Confidence Intervals
Dose-Response Relationship, Drug
Drug Administration Schedule
Endosonography / methods*
Female
Follow-Up Studies
Humans
Intestinal Mucosa / drug effects,  pathology
Logistic Models
Male
Odds Ratio
Predictive Value of Tests
Prospective Studies
Recurrence
Risk Assessment
Sensitivity and Specificity
Severity of Illness Index
Treatment Outcome
Young Adult
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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