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Swaminathan A, Fulforth JM, Frampton CM, Borichevsky GM, Mules TC, Kilpatrick K, Choukour M, Fields P, Ramkissoon R, Helms E, Hanauer SB, Leong RW, Peyrin-Biroulet L, Siegel CA, Gearry RB. The Disease Severity Index for Inflammatory Bowel Disease Is a Valid Instrument that Predicts Complicated Disease. Inflamm Bowel Dis 2023:izad294. [PMID: 38134391 DOI: 10.1093/ibd/izad294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND The disease severity index (DSI) for inflammatory bowel disease (IBD) combines measures of disease phenotype, inflammatory activity, and patient-reported outcomes. We aimed to validate the DSI and assess its utility in predicting a complicated IBD course. METHODS A multicenter cohort of adults with IBD was recruited. Intraclass correlation coefficients (ICCs) and weighted Kappa assessed inter-rater reliability. Cronbach's alpha measured internal consistency of DSI items. Spearman's rank correlations compared the DSI with endoscopic indices, symptom indices, quality of life, and disability. A subgroup was followed for 24 months to assess for a complicated IBD course. Area under the receiver operating characteristics curve (AUROC) and multivariable logistic regression assessed the utility of the DSI in predicting disease progression. RESULTS Three hundred and sixty-nine participants were included (Crohn's disease [CD], n = 230; female, n = 194; mean age, 46 years [SD, 15]; median disease duration, 11 years [interquartile range, 5-21]), of which 171 (CD, n = 99; ulcerative colitis [UC], n = 72) were followed prospectively. The DSI showed inter-rater reliability for CD (ICC 0.93, n = 65) and UC (ICC 0.97, n = 33). The DSI items demonstrated inter-rater agreement (Kappa > 0.4) and internal consistency (CD, α > 0.59; UC, α > 0.75). The DSI was significantly associated with endoscopic activity (CDn=141, r = 0.65, P < .001; UCn=105, r = 0.80, P < .001), symptoms (CDn=159, r = 0.69, P < .001; UCn=132, r = 0.58, P < .001), quality of life (CDn=198, r = -0.59, P < .001; UCn=128, r = -0.68, P < .001), and disability (CDn=83, r = -0.67, P < .001; UCn=52, r = -0.74, P < .001). A DSI of 23 best predicted a complicated IBD course (AUROC = 0.82, P < .001) and was associated with this end point on multivariable analyses (aOR, 9.20; 95% confidence interval, 3.32-25.49). CONCLUSIONS The DSI reliably encapsulates factors contributing to disease severity and accurately prognosticates the longitudinal IBD course.
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Affiliation(s)
- Akhilesh Swaminathan
- Department of Medicine, University of Otago, Christchurch, New Zealand
- Department of Gastroenterology, Christchurch Hospital, New Zealand
| | - James M Fulforth
- Department of Gastroenterology, Waikato Hospital, Hamilton, New Zealand
| | - Chris M Frampton
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | | | - Thomas C Mules
- Department of Medicine, University of Otago, Christchurch, New Zealand
- Department of Gastroenterology, Christchurch Hospital, New Zealand
| | - Kate Kilpatrick
- Department of Gastroenterology, Christchurch Hospital, New Zealand
| | - Myriam Choukour
- Centre Hospitalier Régional Universitaire (CHRU) Nancy, Délégation à la Recherche Clinique et à l'Innovation, Plateforme Maladies Inflammatoires Chroniques de l'Intestin (MICI), Vandoeuvre-lès-Nancy, France
| | - Peter Fields
- Division of Gastroenterology and Hepatology, School of Medicine & Dentistry, University of Rochester, Rochester, NY, USA
| | - Resham Ramkissoon
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Emily Helms
- Department of Gastroenterology, Concord Hospital, Sydney, Australia
| | - Stephen B Hanauer
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rupert W Leong
- Department of Gastroenterology, Concord Hospital, Sydney, Australia
| | - Laurent Peyrin-Biroulet
- Deartment of Gastroenterology, Nancy University Hospital, F-54500 Vandoeuvre-les-Nancy, France
- INSERM, NGERE, University of Lorraine, F-54000 Nancy, France
- INFINY Institute, Nancy University Hospital, F-54500 Vandoeuvre-les-Nancy, France
- FHU-CURE, Nancy University Hospital, F-54500 Vandoeuvre-les-Nancy, France
- Groupe Hospitalier privé Ambroise Paré-Hartmann, Paris IBD Center, 92200 Neuilly sur Seine, France
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Corey A Siegel
- Section of Gastroenterology and Hepatology, Dartmouth Hitchcock Medical Center, LebanonNew Hampshire, USA
| | - Richard B Gearry
- Department of Medicine, University of Otago, Christchurch, New Zealand
- Department of Gastroenterology, Christchurch Hospital, New Zealand
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Fulforth JM, Chen AJ, Falvey JD. Early referral for endoscopy is the most appropriate management strategy in cases of food bolus obstruction. Emerg Med Australas 2019; 31:745-749. [PMID: 30719844 DOI: 10.1111/1742-6723.13238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/06/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the characteristics of patients presenting with oesophageal food bolus obstruction (FBO) who achieve early resolution of symptoms, and to assess the impact of medical therapies on the overall time course of FBO. METHODS A retrospective observational study was performed in a university teaching hospital with regional acute endoscopy services. Patients presenting with symptoms of FBO were identified through clinical coding and demographic, clinical and endoscopic data extracted from the electronic medical record. The primary outcome was the time to resolution defined as the earliest of symptom resolution, endoscopic or surgical intervention or discharge. RESULTS A total of 116 patients presented with symptoms of FBO. Twenty-seven (23.3%) had early resolution of symptoms and were discharged from the ED without acute endoscopy, the remainder were admitted for further management. Patients discharged from the ED presented to hospital sooner after the onset of symptoms (137 vs 288 min, P < 0.05), but did not differ from those admitted in any other characteristic. Seventy-one (61.2%) patients received medical therapy. There was no statistical difference in the time to resolution between those who received medical therapy and those who did not. Furthermore, the use of medical therapy was associated with a delay in referral for endoscopy (140 vs 100 min, P < 0.05). CONCLUSIONS Time from symptom onset to presentation is the only predictor of early resolution from FBO, while medical therapy is ineffective in relieving obstruction and may delay definitive therapy. We recommend the use of an institutional management plan to facilitate early access to endoscopy in cases of FBO.
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Affiliation(s)
- James M Fulforth
- Department of Gastroenterology, Christchurch Public Hospital, Christchurch, New Zealand
| | - Amanda J Chen
- Department of Gastroenterology, Christchurch Public Hospital, Christchurch, New Zealand
| | - James D Falvey
- Department of Gastroenterology, Christchurch Public Hospital, Christchurch, New Zealand
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Fulforth JM, Gearry RB. Inflammatory bowel disease risk and the environment: Where to next? J Gastroenterol Hepatol 2016; 31:1074-5. [PMID: 27240003 DOI: 10.1111/jgh.13375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 03/06/2016] [Accepted: 03/10/2016] [Indexed: 12/09/2022]
Affiliation(s)
- James M Fulforth
- Department of Gastroenterology, Christchurch Hospital, Christchurch, New Zealand
| | - Richard B Gearry
- Department of Gastroenterology, Christchurch Hospital, Christchurch, New Zealand.,Department of Medicine, University of Otago, Christchurch, New Zealand
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