Standardized Assessment Tools for Pediatric IBD … JS, Ferry GD, Mandel FS, Gryboski JD, Kibort,...
Transcript of Standardized Assessment Tools for Pediatric IBD … JS, Ferry GD, Mandel FS, Gryboski JD, Kibort,...
November 2017
Standardized Assessment Tools for Pediatric IBD patients
Use these reference tools to classify the disease type and extent and with measuring disease activity in
the pediatric patient with inflammatory bowel disease.
Pediatric Crohn’s Disease Activity Index (PCDAI)
Pediatric Crohn’s Disease Activity Index (PCDAI): Validated instrument for measuring disease activity in
children and adolescents with Crohn’s disease. Disease activity is determined as a numerical score based
on evaluation of:
Abdominal pain
Number of stools per day
Weight
Linear growth
Physical findings
o Abdominal pain
o Perianal disease
o Extra-intestinal manifestations
Laboratory studies
o Hemoglobin/Hematocrit
o ESR
o Albumin
Functioning and general well-being ( 1 week recall)
Score ranges from 0 to 100
0 – 10 Inactive disease
10 – 30 Mild disease
>30 Moderate to severe disease
References
Hyams JS, Ferry GD, Mandel FS, Gryboski JD, Kibort, PM, Kirschner BS, Griffiths AM, Katz, AJ, Grand RJ, Boyle, JT,
Michener WM ,Levy JS & Lesser ML (1991). Development and Validation of a Pediatric Crohn’s Disease Activity
Index. Journal of Pediatric Gastroenterology and Nutrition. (12): 439 – 447.
Loonen HJ, Griffiths AM, Merkus MP & Derkx HH. (2003) A Critical Assessment of Items on the Pediatric Crohn’s
Disease Activity Index. Journal of Pediatric Gastroenterology and Nutrition (36): 90 – 95.
Hyams J, Markowitz J, Otley A, Rosh J, Mack D, Bousvaros A, Kugathasan S, Pfefferkorn M, Tolia V, Evans J,
Treem W, Wyllie R, Rothbaum R, del Rosario J, Katz A, Mezoff A, Oliva-Hemker M, Lerer T, and Griffiths A (
2005). Evaluation of the Pediatric Crohn Disease Activity Index: A Prospective Multicenter Experience. Journal of
Pediatric Gastroenterology and Nutrition (41): 416 – 421.
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Pediatric Ulcerative Colitis Activity Index (PUCAI)
Pediatric Ulcerative Colitis Activity Index (PUCAI) - Validated instrument for measuring disease activity in
children and adolescents with Ulcerative Colitis. Disease activity is determined as a numerical score
based on evaluation of:
Abdominal pain
Number of stools per day
Stool consistency
Amount of blood in stools
Nocturnal stooling
Activity level
Score ranges from 0 to >85.
0 – 9 Inactive disease
10 -34 Mild disease
35 – 64 Moderate disease
65 – 85 Severe disease
References
Turner, D, Otley, AR, Mack D, Hyams, J, De Bruijne, J, Uusoue K, Walters TD, Zachos M, Mamula P, Beaton,
DE, Steinhart, AH, Griffiths, AM (2007). Development, validation, and Evaluation of a Pediatric Ulcerative
Colitis Activity Index: A Prospective Multicenter Study. Gastroenterology (133): 423 - 432.
Full article: http://www.gastrojournal.org/article/S0016-5085(07)01011-6/pdf
Appendix:
http://download.lww.com/wolterskluwer_vitalstream_com/PermaLink/MPG/A/MPG_2011_04_25_LEE_2017
08_SDC1.pdf
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Turner D, Hyams J , Markovitz J, Lerer T, Mack DR, Evans J, Pfefferkorn M, Rosh J, Kay K, Crandall W,
Keljo D, Otley AR, Kugathasan S, Carvalho R, Oliva-Hemker M, Langton C, Mamula P, Bousvaros A,
Leleiko N & Griffiths, AM (2009). Appraisal of the Pediatric Ulcerative Colitis Activity Index (PCUAI).
Inflammatory Bowel Disease. (15): 1218-1223.
https://www.ncbi.nlm.nih.gov/pubmed/19161178
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Paris Criteria
Paris Criteria - A modification of the Montreal Criteria used in defining disease location and behavior.
The Paris Criteria takes into account:
Age of diagnosis
Extent of disease (location)
Phenotype (behavior)
Growth
Age of diagnosis is categorized as: Birth up to 10 years of age 10 up to 17 years of age 17 – 40 years of age Greater than 40 years of age
Extent of disease
Crohn’s disease or Indeterminate Colitis
The extent of disease is based on : o Macroscopic findings of ulcerations or erosions seen on endoscopic evaluation
o Evidence of small bowel disease found on video capsule, radiographic and/or nuclear
medicine studies.
*The extent of disease is always the worst that was ever documented.
The phenotype for Crohn’s Disease or Indeterminate Colitis describes the behavior of the disease. It is documented as o Inflammatory o Stricturing
o Penetrating
o Both penetrating and stricturing disease.
o The presence or absence of perianal involvement
Ulcerative Colitis
o The extent of disease is based
o Macroscopic findings of ulcerations or erosions seen on endoscopic evaluation
Ulcerative proctitis Left-sided disease (distal to splenic flexure only) Extensive disease (distal to hepatic flexure) Pancolitis (proximal to hepatic flexure)
*The extent of disease is always the worst that was ever documented.
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o Phenotype (Severity) of Ulcerative Colitis is based on PUCAI score and ) is documented as
Remission (less than 10)
Mild (10 – 34)
Moderate (35 – 64)
Severe disease greater than ≥ 65
Growth
o No evidence of growth delay
o Evidence of growth delay
Reference
Levine A, Griffiths A, Markowitz J, Wilson DC, Turner D, Russell RK, Fell, J, Ruemmele FM, Walters T,
Sherlock M, Dubinski M, & Hyams JS. (2011) Pediatric Modification of the Montreal Classification for
Inflammatory Bowel Disease: The Paris Classification. Inflammatory Bowel Disease (17) 6: 1314 -1321.
Full article: http://www.naspghan.org/files/documents/pdfs/training/curriculum-
resources/ibd/Paris_Classification.pdf