Pan-enteric Crohn's capsule (Eliakim) score reliability and responsiveness to change in active Crohn's disease.

Abstract

Pan-enteric capsule endoscopy (PillCam Crohn's capsule [PCC]) is a useful tool in diagnosing and monitoring Crohn's disease (CD). Eliakim score [ES] reliability and strong correlation to Lewis score (LS) and inflammatory biomarkers have been previously demonstrated using PCC in quiescent CD. We aimed to examine ES performance in active CD and its responsiveness to clinical/biochemical change over time. Patients with CD who have started biologics were included, and were prospectively followed with clinical visits, biomarkers, and PCC at baseline, after 14 and 52 weeks. Crohn's disease activity index (CDAI), C-reactive protein (CRP) and fecal-calprotectin (FC) levels were collected, and LS and ES were calculated (independently reviewed by two experienced readers). Inter-class classification (ICC), Spearman's baseline correlation, and repeated-measures correlation (RMC) analyses were performed. 74 patients were included (age: 30.5 [23.3-45.0] years-old, male-50%). 142 PCCs were read (baseline-62, week-14-58, week-52-22). Inter-rater agreement was high for both LS and ES (ICC: 0.872 [p<0.001] and 0.925 [<0.001], respectively). Baseline correlations between FC&ES (r=0.509 [p<0.001]) and FC&LS (r=0.467 [p<0.001]) were comparable (p=0.56). RMC between the inflammatory biomarkers and ES were higher than between the former and LS (Reader-1: CRP- r=0.306 vs. r=0.138 [p=0.057], FC- r=0.479 vs. r=0.297 [p=0.034]; Reader-2 CRP- r=0.376 vs. r=0.204 [p=0.035], FC- r=0.549 vs. r=0.412 [p=0.075]). Moreover, ES was better correlated to CDAI than LS (p=0.036). ES is a reliable scoring system in assessing pan-enteric mucosal inflammation in active CD, and might have a better responsiveness to clinical/biochemical change over time compared to LS.