Validation of the ‘Inflammatory Bowel Disease—Distribution, Chronicity, Activity [IBD-DCA] Score’ for Ulcerative Colitis and Crohn´s Disease
Corinna Lang‐Schwarz, Miriam Angeloni, Abbas Agaimy, Raja Atreya, Christoph Becker, Theresa Dregelies, Silvio Danese, Jean–François Fléjou, Nikolaus Gaßler, Heike I. Grabsch, Arndt Hartmann, Kateřina Kamarádová, Anja A. Kühl, Gregory Y. Lauwers, Alessandro Lugli, Irıs D. Nagtegaal, Markus F. Neurath, Georg Oberhuber, Laurent Peyrin‐Biroulet, Timo Räth, Robert H. Riddell, Carlos A. Rubio, Kieran Sheahan, Britta Siegmund, Herbert Tilg, Vincenzo Villanacci, Maria Westerhoff, Fulvia Ferrazzi, Michael Vieth
Abstract
BACKGROUND AND AIMS: Histological scoring plays a key role in the assessment of disease activity in ulcerative colitis [UC] and is also important in Crohn´s disease [CD]. Currently, there is no common scoring available for UC and CD. We aimed to validate the Inflammatory Bowel Disease [IBD]-Distribution [D], Chronicity [C], Activity [A] score [IBD-DCA score] for histological disease activity assessment in IBD. METHODS: Inter- and intra-rater reliability were assessed by 16 observers on biopsy specimens from 59 patients with UC and 25 patients with CD. Construct validity and responsiveness to treatment were retrospectively evaluated in a second cohort of 30 patients. RESULTS: Inter-rater reliability was moderate to good for the UC cohort (intraclass correlation coefficients [ICCs] = 0.645, 0.623, 0.767 for D, C, and A, respectively) and at best moderate for the CD cohort [ICC = 0.690, 0.303, 0.733 for D, C, and A, respectively]. Intra-rater agreement ranged from good to excellent in both cohorts. Correlation with the Nancy Histological Index [NHI] was moderate and strong with the Simplified Geboes Score [SGS] and a Visual Analogue Scale [VAS], respectively. Large effect sizes were obtained for all three parameters. External responsiveness analysis revealed correlated changes between IBD-DCA score and NHI, SGS and VAS. CONCLUSIONS: The IBD-DCA score is a simple histological activity score for UC and CD, agreed and validated by a large group of IBD specialists. It provides reliable information on treatment response. Therefore, it has potential value for use in routine diagnostics as well as clinical studies.