A simple endoscopic score modified for the Upper Gastrointestinal Tract in Crohn's Disease [UGI-SES-CD]: A report from the imagekids study

Oren Ledder, Dan Turner, David Mack, Eric Benchimol, Jorge Davila, Tony Otley, Kathy O'Brien, Jeff Hyams, Doug Moote, Bob Baldassano, Judith Kelsen, Sudha Anupindi, Shehzad Saeed, Ted Denson, Daniel Lemberg, Jared Silverstein, Neal Leleiko, David Grand, Lucia Riaza, Victor NavasFrank Ruemmele, Laureline Berteloo, Raanan Shamir, Izabela Herman-Sucharska, Lissy de Ridder, Jessie Hulst, Maarten Lequin, Martin Wasser, Richard Russell, Johanna Escher, Emily Stenhouse, Sibylle Koletzko, Michal Amitai, Osnat Konen, Anat Ilivitzki, Elhamy Bekhit, Daniel Moses

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Objective There is no standardized endoscopic description of upper gastrointestinal [UGI] disease in Crohn's disease [CD]. We prospectively applied the Simple Endoscopic Score for CD [SES-CD] to the UGI tract as a planned sub-study of the multicentre prospective ImageKids study. We aimed to assess the utility of the UGI-SES-CD and its clinical significance in paediatric CD. Design Patients underwent an oesophagogastroduodenoscopy [EGD], ileocolonoscopy, and magnetic resonance enterography [MRE] with explicit clinical data recorded. SES-CD was scored at each region [oesophagus, stomach body, antrum, and duodenum]. Half of the patients were followed for 18 months, when a repeat MRE was performed. Results A total of 202 children were included 56% males, mean age 11.5 ± 3.2 years, median weighted Paediatric Crohn's Disease Activity Index [wPCDAI 25]). UGI-SES-CD score ranged 0-17, with 95 [47%] having a UGI-SES-CD ≥1; no narrowing was detected. UGI-SES-CD ≥1 was associated with higher: wPCDAI [32.5 vs 20; p = 0.03]; Physician's Global Assessment [PGA] of inflammation (45 mm visual analogue score [VAS] vs 30 mm VAS; p = 0.04); ileocolonoscopic SES-CD [10 vs 7; p = 0.004], faecal calprotectin [717 μg/g vs 654 μ/g; p= 0.046]; and radiological global assessment of damage by MRE [7 mm VAS vs 0; p = 0.04]. In all, 81 patients were followed for 18 months and no association was identified between initial UGI SES-CD and markers of disease course such as surgery, MRE assessment, or treatment escalation. Conclusion UGI-SES-CD is an easily reported objective scoring system and is associated with a more severe disease phenotype but not with disease course.
Original languageEnglish
Pages (from-to)1073-1078
JournalJournal of Crohn's and Colitis
Issue number9
Publication statusPublished - 2018
Externally publishedYes

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