Introduction
The Inflammatory Bowel Disease (IBD) Disk represents a self-administered questionnaire that can facilitate, in real time, assessment of IBD related disability, and IBD-related daily life burden1,2. Surrogate markers of IBD activity tend to associate with increased disability. Intestinal ultrasound (IUS) is a non-invasive tool that can objectively and accurately define disease activity and complications in IBD patients.
Aims & Methods
The aim of our study was to investigate the correlation between IBD-Disk and IUS in IBD patients. We performed a cross-sectional study that included formally diagnosed IBD patients who underwent IUS and subsequently completed the IBD-Disk questionnaire. Active disease on IUS was defined as bowel wall thickness (BWT) >3 mm at the most affected bowel segment. The overall IBD-Disk score was calculated as the sum of its 10 components, ranging from 0 to 100 (best score: 0, worst score: 100). We explored the correlation between IBD-Disk and its components with IUS. We additionally investigated the correlation of IBD-related daily life burden with IUS. (IBD-Disk total score > 40: high IBD related daily life burden vs IBD-Disk total score ≤ 40: low IBD related daily life burden2).
Results
We included 69 patients (Table 1), who underwent IUS for disease monitoring (56.5%) and symptoms suggestive of disease flare (43.5%). Median IBD-Disk total score in our cohort was 48 (IQR 19-56.5). Median IBD-Disk total score was 52 (IQR 47-58.5) in IUS active vs 16 (IQR 6-23) in IUS inactive patients (p<0.001). The area under the ROC curve of IBD-Disk total score in predicting IUS activity was 0.909 (95% C.I: 0.819-0.99, p<0.001). IBD-Disk score >33 predicted disease activity in IUS with 93.5% sensitivity and 91.3% specificity. We observed a moderate correlation between IBD-Disk score and BWT (ρ=0.554, p<0.001) as well as between IBD-Disk score and C-reactive protein (ρ=0.686, p<0.001). Among the components of the IBD-Disk, 7/10 (abdominal pain, regulating defecation, education/work, sleep, energy, sexual function and interpersonal interactions) manifested a moderate correlation with BWT. IBD-Disk score > 40 was found in 40/46 (87%) of IUS active and 2/23 (8.7%) of IUS inactive patients, while IBD-Disk score ≤ 40 was found in 6/46 (13%) of IUS active and 21/23 (91.3%) of IUS inactive patients respectively (p<0.001). Median BWT was 2.1 mm (IQR 1.6-2.9) in patients with IBD-Disk score ≤ 40 and 6 mm (IQR 4.8-6.8) in patients with IBD-Disk score > 40 (p<0.001).
PATIENT CHARACTERISTICS |
CROHN'S DISEASE
n= 42 |
ULCERATIVE COLITIS
n= 27 |
SEX | 18 males/ 24 females | 12 males/ 15 females |
AGE [median, IQR] | 34 [23.8-44.8] | 40 [32-55] |
AGE AT FIRST DIAGNOSIS (Montreal Classification) | Α1:10 Α2:31 Α3:1 | <40 years: 19 >40 years: 8 |
DISEASE DISTRIBUTION (Montreal Classification)
| L1:24, L2:4, L3:14, L4:1 | E1:1 E2:19 E3:12 |
DISEASE BEHAVIOR
PERIANAL DISEASE-p | B1:21, B2:18, B3:10
p:4 |
|
OPERATED PATIENTS | n =11 | n=0 |
CLINICAL ACTIVITY SCORES | HBI
<5: 26
5-7: 12
8-16: 4
>16: 0 |
PARTIAL MAYO SCORE
< 2: 6
2‐4: 8
5‐6: 6
7‐9: 7
|
CURRENT TREATMENT | Biologics/JAK Inhibitors
(IFX, ADA, VEDO, UST): 38 IMM (AZA, MTX): 2 Corticosteroids: 1 5-ASA: 0
No TRT: 2 | Biologics/JAK Inhibitors
(IFX, ADA, VEDO, UST, TOFA): 19 IMM (AZA, MTX): 1 Corticosteroids: 3 5-ASA: 7
No TRT: 0 |
Table 1: Patients characteristics
HBI: Harvey Bradshaw Index, IFX: Infliximab, ADA: Adalimumab, VEDO: Vedolizumab, UST: Ustekinumab, TOFA: Tofacitinib, IMM: Immunomodulators, AZA: Azathioprine, MTX: Methotrexate, 5-ASA: 5-Aminosalicylates, TRT: Treatment
Conclusion
IBD-Disk displayed a significant correlation with IUS evidence of disease activity in IBD patients. Active disease in IUS was significantly correlated with a high IBD-related daily life burden as expressed by IBD-Disk total score > 40. IBD-Disk could be used in clinical practice to evaluate disease activity and severity in IBD patients.
References
1) S. Ghosh et al. Inflamm Bowel Dis. 2017, 333-340
2) S. Tadbiri et al. Journal Crohns Colitis, 2021, 766–773
