Histopathology Scoring Systems of Stenosis Associated With Small Bowel Crohn’s Disease: A Systematic Review.
Gastroenterology. 2019 Aug 30;:
Authors: Gordon IO, Bettenworth D, Bokemeyer A, Srivastava A, Rosty C, Hertogh GE, Robert ME, Valasek MA, Mao R, Kurada S, Harpaz N, Borralho P, Pai RK, Pai RK, Odze R, Feakins R, Parker CE, Nguyen T, Jairath V, Baker ME, Bruining DH, Fletcher JG, Feagan BG, Rieder F, Stenosis Therapy and Anti-Fibrotic Research (STAR) Consortium
BACKGROUND & AIMS: Stenosis is a common complication of Crohn’s disease (CD) that has no effective medical therapy. Development of anti-fibrotic agents will require testing in randomized controlled trials. Computed tomography enterography- and magnetic resonance enterography-based technologies might be used to measure outcomes in these trials. These approaches have been validated in studies of patients with symptomatic strictures who underwent imaging evaluations, followed by resection with histopathologic grading of the intestinal tissue for inflammation and/or fibrosis (the reference standard). Imaging findings have correlated with findings from quantitative or semi-quantitative histologic evaluation of the degree of fibromuscular stenosis and/or inflammation on the resection specimen. However, it is not clear whether histologic findings are an accurate reference standard. We performed a systematic review of all published histologic scoring systems used to assess stenosing CD.
METHODS: We performed a comprehensive search of the Embase and Medline of studies through March 13, 2019 that used a histologic scoring system to characterize small bowel CD and assessed inflammatory and fibrotic alterations within the same adult subject. All scores fitting the criteria were included in our analysis, independently of the presence of stricturing disease, as long as inflammation and fibrosis were evaluated separately but in the same scoring system.
RESULTS: We observed substantial heterogeneity among scoring systems, which were not derived using modern principles for evaluative index development. None had undergone formal validity or reliability testing. None of the existing indices had been constructed according to accepted methods for development of evaluative indices. Basic knowledge regarding their operating properties were lacking. Specific indices to evaluate the important pathological component of myofibroblast hypertrophy or hyperplasia have not been proposed.
CONCLUSIONS: In a systematic review of publications, we found a lack of validated histopathologic scoring systems for assessment of fibromuscular stenosis. Data that describe the operating properties of existing cross-sectional imaging techniques for stenosing CD should be questioned. Development and validation of a histopathology index is an important research priority.
PMID: 31476299 [PubMed – as supplied by publisher]