Me: 22.2.06 Gent.mi, Vi comunico che il 17.3 alle ore 10 si ... - SIGENP

Me: 22.2.06Gent.mi,Vi comunico che il 17.3 alle ore 10 si svolgerà presso l’AulettaImmaturi del Dipartimento di Pediatria del Policlinico Umberto I diRoma, Viale Regina Elena 324,Riunione per avvio e stesura del Progetto per lacreazione di uno score endoscopico per le MICI in etàpediatricaVi allego il Protocollo di StudioLa riunione è aperta ad 1 rappresentante per Centro diGastroenterologia e/o Endoscopia in ambito SIGENP, SICP e SIED,in attesa di incontrarVi a Roma,C. Romano (romanoc@unime.it)1

ENDOSCOPY IN INFLAMMATORY BOWEL DISEASE:PROPOSAL OF NEW PEDIATRIC SCORE ACTIVITY INDEX (PSAI)IBD and Endoscopy SIGENP Study-GroupsGianluigi dè Angelis ( Parma), O. Borrelli ( Roma) e C. Romano ( Messina)INTRODUCTIONEndoscopy is a gold standard in the diagnosis and follow-up of inflammatory bowel disease(IBD) and can be considered most sensitive for evaluating mucosal changes and obtaining tissue forhistological evaluation (1). It can determines location and severity of disease and plays animportant role in managing complications of IBD, such as bleeding and strictures (2). Endoscopyplays an integral role in differentiating IBD from other disease entities that may have similarclinical presentation, such as colitis due to infections, allergy etc, etc. Endoscopic findings ofulcerative colitis (UC) depend by extent and phase of disease activity. In the remission stage, thesurface of the mucosa is often granulated. Additionally, the vessels in the submucosa are rarefied(3). Pseudopolyps and a loss of haustration are signs of chronic and important disease (4). Theacute stage of the illness is characterized by patchy redness, edema and mucosal hemorrhages.Finally, ulcers can dominate the endoscopic imaging. The endoscopic findings of Crohn’s Disease(CD) is highly variable and changes with disease activity and duration. Classically is characterizedby “skyp areas” of disease separated by normal mucosa (4). Typical endoscopic signs of CD arealso the discontinous spread, punched-out aphtous ulcers as result of submucosal lymphoid follicleexpansion (5).A quantitative endoscopic index of CD severity has been developed by the GETAID(Groupe d’Etudes Therapeutiques des Affections Inflammatories du Tube Digestif ) (6). This indexuse objective endoscopic criteria such as the presence of ulceration and location of disease, and theresults have been shown to be not reproducible between different medical centers.Any endoscopic score has failed to show significant correlation with patient symptoms orobjective indicators of disease activity and several clinical scoring system have been proposed forthis surpose (Truelove-Witts categories, Powel-Tuck score etc ) (7,8).2

BACKGROUNDEndoscopy determines the severity and location of disease, can quantify intestinal mucosadamage and the characteristic anatomic features underlying this disease. A synopsis of all tests(radiological, clinical and sierological) are necessary before a “ mosaic diagnosis” of IBD isobtained. Pediatric endoscopic score for IBD is not estabilished and when performed, endoscopynecessitates to be univocal in macroscopical interpretation and description of lesions.METHODS and OBJECTIVESThe endoscopic major features of IBD are:- rectal involvement- skip areas/symmetry- ulcerations- cobblestoning- mucosal bridging- mucosal friability- granularityThe SIGENP Group will work to validate an Pediatric Score Activity Index (PSAI) forIBD and :- define major lesions in active IBD- define indications and controindications for endoscopy in IBD- define major endoscopic findings for differentiation acute colitis from ulcerative colitisor Crohn’s Disease- define early lesions suggestive for dysplasia or mucosal complications- define major criteria for recurrence of endoscopic lesions in post-operative IBD1. Working Group2. Research bibliography3. Working Meeting in 3./2006DESIGN OF STUDY3

BIBLIOGRAPHY1. Surawicz CM et al, Rectal biopsy to distinguish acute self-limited colitis from idiopaticinflammatory bowel disease, Gastroenterology 1984; 86: 104-1132. Schumacher G et al, First attack of inflammatory bowel disease and infectious colitis, ScandJournal Gastroenterol Suppl. 1993;198:1-243. Price AB et al, Overlap in the spectrum of non-specific inflammatory bowel disease- “colitisindeterminate”, J Clin Pathol 1998,31:566-5714. Quinn PG et al, The role of endoscopy in inflammatory bowel disease, Med Clin North Am.1994; 78:1333-13525. Seo M et al, An index of disease activity in patients with ulcerative colitis, Am JGastroenterol , 87:971-976, 19926. Mary JY et al, Development and validation of an endoscopic index of the severity forCrohn’s Disease: a prospective multicentre study (GETAID)- Gut- 1989;30:983-9897. Truelove SC et al, Cortisone in ulcerative colitis. Final Report on therapeutic trial, Br Med J2:1041-1048, 19658. Powel-Tuck J et al, A comparision of oral prednisone given as single or multiple daily dosefor active proctocolitis. Scand J Gastroenterol, 13:833-837, 19784