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Zittan E, Steinhart AH, Aran H, Milgrom R, Gralnek IM, Zelber-Sagi S, Silverberg MS. The Toronto IBD Global Endoscopic Reporting [TIGER] Score: A Single, Easy to Use Endoscopic Score for Both Crohn's Disease and Ulcerative Colitis Patients. J Crohns Colitis 2022; 16:544-553. [PMID: 34272937 DOI: 10.1093/ecco-jcc/jjab122] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Indexed: 12/07/2022]
Abstract
BACKGROUND AND AIMS We constructed the Toronto IBD Global Endoscopic Reporting [TIGER] score for inflammatory bowel disease [IBD]. The aim of our study was to develop and validate the TIGER score against faecal calprotectin [FC], C-reactive protein [CRP], and IBD Disk. METHODS A cross-sectional study was performed among 113 adult patients (60 Crohn's disease [CD] and 53 ulcerative colitis [UC]). In the development and usability phase, blinded IBD experts reviewed and graded ileocolonoscopy videos. In the validity phase the TIGER score was compared with: [1] the Simple endoscopic Score for CD [SES-CD] and the Mayo endoscopic score in CD and UC, respectively; [2] FC and CRP; and [3] IBD Disk. RESULTS Inter-observer reliability of the TIGER score per segment between reviewers was excellent: interclass correlation coefficient [ICC] = 0.94 [95% CI: 0.92-0.96]. For CD patients, overall agreement per segment between SES-CD and TIGER was 91% [95% CI: 84-95] with kappa coefficient 0.77 [95% CI: 0.63-0.91]. There was a significant correlation between TIGER and CRP [p <0.0083], and TIGER and FC [p <0.0001]. In addition, there was significant correlation between TIGER and IBD Disk [p <0.0001]. For UC patients, overall agreement per segment between Mayo endoscopic score and TIGER was 84% [95% CI: 74%-90%] and kappa coefficient 0.60 [95% CI: 0.42-0.808]. There was a significant correlation between TIGER and FC [p <0.0001]. There was a significant correlation between TIGER and IBD Disk [p <0.0001]. CONCLUSIONS The TIGER score is a reliable and simple novel endoscopic score that can be used for both CD and UC patients and captures full endoscopic disease burden.
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Affiliation(s)
- E Zittan
- Abraham and Sonia Rochlin IBD Unit, Department of Gastroenterology and Liver Diseases, Emek Medical Center, Afula, Israel.,Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - A H Steinhart
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - H Aran
- Abraham and Sonia Rochlin IBD Unit, Department of Gastroenterology and Liver Diseases, Emek Medical Center, Afula, Israel
| | - R Milgrom
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - I M Gralnek
- Abraham and Sonia Rochlin IBD Unit, Department of Gastroenterology and Liver Diseases, Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - S Zelber-Sagi
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - M S Silverberg
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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Zittan E, Steinhart AH, Aran H, Milgrom R, Gralnek IM, Zelber-Sagi S, Silverberg MS. The Toronto IBD Global Endoscopic Reporting [TIGER] Score: A Single, Easy to Use Endoscopic Score for Both Crohn's Disease and Ulcerative Colitis Patients. J Crohns Colitis 2022. [PMID: 34272937 DOI: 10.1093/ecco-jcc/jjab122[publishedonlinefirst:2021/07/18]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND AND AIMS We constructed the Toronto IBD Global Endoscopic Reporting [TIGER] score for inflammatory bowel disease [IBD]. The aim of our study was to develop and validate the TIGER score against faecal calprotectin [FC], C-reactive protein [CRP], and IBD Disk. METHODS A cross-sectional study was performed among 113 adult patients (60 Crohn's disease [CD] and 53 ulcerative colitis [UC]). In the development and usability phase, blinded IBD experts reviewed and graded ileocolonoscopy videos. In the validity phase the TIGER score was compared with: [1] the Simple endoscopic Score for CD [SES-CD] and the Mayo endoscopic score in CD and UC, respectively; [2] FC and CRP; and [3] IBD Disk. RESULTS Inter-observer reliability of the TIGER score per segment between reviewers was excellent: interclass correlation coefficient [ICC] = 0.94 [95% CI: 0.92-0.96]. For CD patients, overall agreement per segment between SES-CD and TIGER was 91% [95% CI: 84-95] with kappa coefficient 0.77 [95% CI: 0.63-0.91]. There was a significant correlation between TIGER and CRP [p <0.0083], and TIGER and FC [p <0.0001]. In addition, there was significant correlation between TIGER and IBD Disk [p <0.0001]. For UC patients, overall agreement per segment between Mayo endoscopic score and TIGER was 84% [95% CI: 74%-90%] and kappa coefficient 0.60 [95% CI: 0.42-0.808]. There was a significant correlation between TIGER and FC [p <0.0001]. There was a significant correlation between TIGER and IBD Disk [p <0.0001]. CONCLUSIONS The TIGER score is a reliable and simple novel endoscopic score that can be used for both CD and UC patients and captures full endoscopic disease burden.
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Affiliation(s)
- E Zittan
- Abraham and Sonia Rochlin IBD Unit, Department of Gastroenterology and Liver Diseases, Emek Medical Center, Afula, Israel.,Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - A H Steinhart
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - H Aran
- Abraham and Sonia Rochlin IBD Unit, Department of Gastroenterology and Liver Diseases, Emek Medical Center, Afula, Israel
| | - R Milgrom
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - I M Gralnek
- Abraham and Sonia Rochlin IBD Unit, Department of Gastroenterology and Liver Diseases, Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - S Zelber-Sagi
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - M S Silverberg
- Mount Sinai Hospital, Zane Cohen Centre for Digestive Diseases, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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Ye M, Joosse ME, Liu L, Sun Y, Dong Y, Cai C, Song Z, Zhang J, Brant SR, Lazarev M, Li X. Deletion of IL-6 Exacerbates Colitis and Induces Systemic Inflammation in IL-10-Deficient Mice. J Crohns Colitis 2020; 14:831-840. [PMID: 31679013 PMCID: PMC7346894 DOI: 10.1093/ecco-jcc/jjz176] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Interleukin 6 [IL-6] or its receptor is currently a candidate for targeted biological therapy of inflammatory bowel disease [IBD]. Thus, a comprehensive understanding of the consequences of blocking IL-6 is imperative. We investigated this by evaluating the effects of IL-6 deletion on the spontaneous colitis of IL-10-deficient mice [IL-10-/-]. METHODS IL-6/IL-10 double-deficient mice [IL-6-/-/IL-10-/-] were generated and analysed for intestinal inflammation, general phenotypes and molecular/biochemical changes in the colonic mucosa compared with wild-type and IL-10-/- mice. RESULTS Unexpectedly, the IL-6-/-/IL-10-/- mice showed more pronounced gut inflammation and earlier disease onset than IL-10-/- mice, both locally [colon and small bowel] and systemically [splenomegaly, ulcerative dermatitis, leukocytosis, neutrophilia and monocytosis]. IL-6-/-/IL-10-/- mice exhibited elevations of multiple cytokines [IL-1β, IL-4, IL-12, TNFα] and chemokines [MCP-1 and MIG], but not IFN-γ [Th1], IL-17A and IL-17G [Th17], or IL-22 [Th22]. FOXP3 and TGF-β, two key factors for regulatory T [Treg] cell differentiation, were significantly down-regulated in the colonic mucosa, but not in the thymus or mesenteric lymph nodes, of IL-6-/-/IL-10-/- mice. CTLA-4 was diminished while iNOS was up-regulated in the colonic mucosa of IL-6-/-/IL-10-/- mice. CONCLUSION In IL-10-/- mice, complete IL-6 blockade significantly aggravates gut inflammation, at least in part by suppressing Treg/CTLA-4 and promoting the IL-1β/Th2 pathway. In addition, the double mutant exhibits signs of severe systemic inflammation. Our data define a new function of IL-6 and suggest that caution should be exercised when targeting IL-6 in IBD patients, particularly those with defects in IL-10 signalling.
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Affiliation(s)
- Mei Ye
- Division of Gastroenterology, Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA,Department of Gastroenterology, Zhongnan Hospital, Wuhan University, Hubei Province, China
| | - Maria E Joosse
- Division of Gastroenterology, Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Ling Liu
- Division of Gastroenterology, Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA,Department of Gastroenterology, West China Hospital, Sichuan University, Sichuan Province, China
| | - Yu Sun
- Division of Gastroenterology, Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Ying Dong
- Division of Gastroenterology, Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Changchun Cai
- Division of Gastroenterology, Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Zhenmei Song
- Division of Gastroenterology, Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Jennifer Zhang
- Division of Gastroenterology, Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Steven R Brant
- Division of Gastroenterology, Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Mark Lazarev
- Division of Gastroenterology, Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Xuhang Li
- Division of Gastroenterology, Department of Medicine, Johns Hopkins Medicine, Baltimore, MD, USA,Corresponding author: Xuhang Li, PhD, Department of Medicine, Division of Gastroenterology, Johns Hopkins University School of Medicine, 720 Rutland Ave., Ross 918, Baltimore, MD 21205, USA.
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