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Ledder, Oren; Church, Peter; Cytter-Kuint, Ruth; Martinez-Leon, Maria; Sladek, Malgorzata; Coppenrath, Eva; Weiss, Batia; Yerushalmi, Baruch; Martin de Carpi, Javier; Duchano, Larisa; Towbin, Alexander; Assa, Amit; Shaoul, Ron; Mearin, M. L.; Alex, George; Griffiths, Anne; Tumer, Dan (2018): A Simple Endoscopic Score Modified for the Upper Gastrointestinal Tract in Crohn's Disease [UGI-SES-CD]: A Report From the ImageKids Study. In: Journal of Crohns & Colitis, Vol. 12, No. 9: pp. 1073-1078
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Abstract

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 mu g/g vs 654 mu/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.