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Current best practice for disease activity assessment in IBD

Key Points

  • Objective assessment of disease activity in IBD is important for guiding subsequent therapy as part of a 'treat to target' strategy

  • Multiple domains of disease activity assessment exist in IBD (symptoms, endoscopy, histology, radiology, biomarkers and quality of life), and targets should be recognized as goals for therapy within each domain

  • Confusing terminology and the use of composite indices (combining symptom assessment with objective measurements of quality of life or inflammation) confound the formal evaluation of disease activity

  • Biomarkers are useful adjuncts to monitor disease activity in both ulcerative colitis and Crohn's disease

  • Assessment of quality of life is an important aspect of medical decision-making, as improving quality of life is a major goal of therapy

Abstract

Therapeutic advances in the management of IBD have led to a paradigm shift in the assessment of IBD disease activity. Beyond clinical remission, objective assessment of inflammation is now critical to guiding subsequent therapy as part of a 'treat to target' strategy. Multiple domains of disease activity assessment in IBD exist, each of which has its merits, although none are perfect. The aim of this Review is to comprehensively evaluate measures of disease activity in both ulcerative colitis and Crohn's disease, including clinical, endoscopic, histological and radiological assessment tools, as well as the use of biomarkers and quality of life evaluation. A subjective appraisal of the best indices for use in clinical practice is provided, based on index validation, responsiveness and experience in clinical trials, international specialist opinion, and practicality and suitability for use in clinical practice. This Review aims to enable the reader to gain confidence in IBD disease activity assessment and to give ready access to the necessary tools.

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Figure 1: Domains of disease activity assessment.

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Correspondence to Alissa J. Walsh.

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A.J.W. has served as an advisory board member for AbbVie, Ferring, Janssen-Cilag, Hospira and Takeda. She has received honoraria for speaking from AbbVie, Ferring, Janssen-Cilag and Shire, and has received grants for support of research from AbbVie, Ferring, Janssen-Cilag and Shire. R.V.B. has received conference attendance support from Ferring, Janssen, and Takeda, and honoraria for speaking from Abbvie, Janssen-Cilag and Shire, and S.P.L.T. has received grants for research support from AbbVie, Lilly, Norman Collison Foundation, UCB and Vifor. He has received consulting and/or speaker fees from AbbVie, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Cosmo, Ferring, Giuliani SpA, GlaxoSmithKline, Lilly, MSD, Neovacs, Novartis, Norman Collison Foundation, Novo Nordisk, Pfizer, Proximagen, Receptos, Shire, Sigmoid Pharma, Takeda, TopiVert, UCB, VHsquared, Vifor, and Warner Chilcott.

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List of disease activity indices for ulcerative colitis (PDF 281 kb)

Supplementary information S2 (tables)

Simple Clinical Colitis Activity Index (SCCAI) (PDF 656 kb)

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Search methodology (PDF 104 kb)

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Walsh, A., Bryant, R. & Travis, S. Current best practice for disease activity assessment in IBD. Nat Rev Gastroenterol Hepatol 13, 567–579 (2016). https://doi.org/10.1038/nrgastro.2016.128

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