Assessment of a new score for capsule endoscopy in pediatric Crohn's disease (CE-CD)

Background and study aims Two scores have been implemented to standardize capsule endoscopic (CE) findings in patients with Crohn's disease (CD): Lewis score ( LS) and Capsule Endoscopy Crohn's Disease Activity Index (CECDAI). Both have limitations and are not well validated in the pediatric population. The aim of our study was to assess a new score ( capsule endoscopy - Crohn's disease index, CE-CD) in pediatric patients with CD and to compare it to preexisting scores.Patients and methods This was a double-center, retrospective study involving pediatric subjects with CD who underwent CE. Correlation analyses between CE-CD, endoscopy scores and noninvasive markers of disease activities were performed. The ability of different CE scores to predict clinical and endoscopic outcomes was evaluated with regression and survival analyses.Results A total of 312 subjects were analyzed. The CE-CD score showed a moderate (Pearson's r = 0.581, P < 0.001) and strong (r = 0.909, P < 0.001) association with LS and CECDAI, respectively. CE-CD was a statistically significant predictor of hospitalization (hazard ratio [HR]1.061), treatment escalation (HR 1.062), steroid therapy (HR 1.082), clinical (HR 1.064) and endoscopic ( HR 1.060) relapse over the twenty-four months (P < 0.001). Subjects with mucosal inflammation according to CE-CD ( CE-CD >= 9) had worse outcomes compared to patients without inflammation ( CE-CD < 9) (Log rang test < 0.001).Conclusions The CE-CD score is a simple, reliable, reproducible, and predictive score for evaluation of small bowel inflammation in pediatric patients with CD. Prospective validation is needed to confirm the applicability of this new index in clinical practice.