Improving Crohn’s Disease Evaluations in Kids

In people with Crohn's disease, a chronic inflammatory bowel condition, symptoms or how they feel may not line up with actual inflammation in their gut. 

This mismatch creates challenges for accurately measuring how well a treatment is truly working, especially for children.

Currently, many gastroenterologists use symptoms and blood tests to gauge improvement. The "gold standard" for evaluating Crohn's disease is a colonoscopy, which offers more reliable results. But the current scoring system for colonoscopies is complicated and isn't used in everyday practice.

And until now, no colonoscopy score has ever been tested or validated in children with Crohn's disease.

But researchers at Michigan Medicine C.S. Mott Children's Hospital have developed a new simplified version of the colonoscopy score to accurately measure the severity of Crohn's disease in the lining of the gut.

The new Simplified Endoscopic Mucosal Assessment for Crohn's Disease, or SEMA-CD, measures the amount of inflammation and damage to the lining of the intestines visualized through a colonoscopy – or what's known as endoscopic mucosal improvement or healing.

This scoring tool replicates the gold standard method for evaluating whether therapy is successfully healing inflammation but in more efficient way that can be used for patients of all ages, according to findings in journal Inflammatory Bowel Diseases.

"With Crohn's disease, people's symptoms may improve even if they still have inflammation or it's even worsened. Or they may have symptoms that don't match up with the inflammation," says lead author Jeremy Adler, M.D., M.Sc., pediatric gastroenterologist and researcher at Mott. "The current methods of accurately evaluating the disease's progression don't apply well to everyday practice.

"It's important to have a score that's simple, quick and easy to use when taking care of patients and can help guide decisions about continuing or changing therapy. It's especially important to have a score that works for children."

The five-point ranking colonoscopy score is the first to be developed and tested in children.

Crohn's disease, which causes chronic inflammation that can damage any part of the gut, affects around 60,000 children in the U.S. It can cause a wide range of symptoms from abdominal pain and diarrhea to blood in the stool and blockages of the bowel. This may trigger abdominal pain, fatigue, weight loss and malnutrition.

Researchers validated the new scoring tool through evaluations of 57 recorded pediatric colonoscopies. Pediatric gastroenterologists from across the country evaluated them and scored them blindly using both the new colonoscopy scores and old ones (known as Simple Endoscopic Score for Crohn's Disease (SES-CD).

Adler and colleagues found that patients who have more severe or extensive mucosal inflammation tend to have a more aggressive clinical course. Achieving mucosal improvement is associated with improved disease outcomes and a higher likelihood of maintaining sustained steroid-free clinical remission.

Not only will the new colonoscopy score help evaluate patients' outcomes but also contribute to research, Adler notes. Currently, endoscopic mucosal improvement isn't routinely recorded in clinical databases collecting information on Crohn's disease and ulcerative colitis.

Evaluating mucosal healing is also required by the U.S. Food and Drug Administration for approval of medications. Adler says the new score may especially help with getting medications approved for children with Crohn's disease, as most drugs are currently not approved for pediatric patients.

"All high-quality research needs to include both information about symptoms and inflammation," Adler says. "Having a simple score that everyone can use will make it easier to record clinical information on a large scale to both improve care and facilitate new research for both adults and children with Crohn's disease."

The research was funded by the Crohn's and Colitis Foundation's Pediatric Resource Organization for Kids with Inflammatory Intestinal Diseases, also known as PRO-KIIDS.

Study Cited: "Development and Testing of a New Simplified Endoscopic Mucosal Assessment for Crohn's Disease: The SEMA-CD," Inflammatory Bowel Diseases. DOI: 10.1093/ibd/izaa307