92 Use of the Patient Reported Outcomes Measurement Information System (PROMIS) in a Pediatric Cohort With Inflammatory Bowel Disease (IBD)

Abstract

BACKGROUND AND AIM. Bowel ultrasonography (US) is a well-established non-invasive tool in the evaluation of pediatric Crohn's disease. There are only few data on its role in Ulcerative Colitis (UC). This is a prospective, blind comparative study versus colonoscopy to evaluate the usefulness of US in assessing the extent and activity of disease in pediatric UC. METHODS. Sixty consecutive pediatric patients (pts) (median age 15 years; range 221) with an established diagnosis of UC and suspected disease flare-up were prospectively enrolled. Fifty pts were finally eligible for the study. All underwent clinical evaluation, bowel US with Color-Doppler examination and colonoscopy. For each patient Pediatric Ulcerative Colitis Activity Index (PUCAI) and Mayo endoscopic subscore (MS) were calculated. Blind US was performed the day before endoscopy in all pts. The US assessed parameters were Bowel Wall Thickness (BWT >3 mm), BW stratification, BW vascularity, presence of haustra coli and enlarged mesenteric lymph nodes. RESULTS. The endoscopic extent of disease was independently confirmed in 47/50 pts by US, that yielded a 90% concordance with endoscopy (95%CI 0.82-0.96). US sensitivity (SE) and specificity (SP) in the different colonic segments are reported in the table. Multiple regression analysis showed that variables with an independent predictive value of severity at endoscopy were increased BWT (p<0.0008), BW vascularity (p<0.002), loss of haustra (p=0.031) and loss of BW stratification (p=0.021). Each variable was assigned a value of 1 if present. The final US score ranged from 0 to 4. The alteration of more than 2 parameters had a SE of 100% and a SP of 93% for severe disease (AUC 0.98). The US score strongly correlated with PUCAI (r=0.94) and MS (r=0.90) (p<0.0001) (Figure 1). CONCLUSIONS. Colonic US is a useful first line diagnostic tool in pediatric UC, particularly in the setting of severe disease. US helps to assess the extent and activity of disease and to estimate the severity of a flare-up, prior to further invasive tests. US SENSITIVITY AND SPECIFICITY IN THE DIFFERENT COLONIC SEGMENTS