PT  - JOURNAL ARTICLE
AU  - Siegel, Corey A
AU  - Whitman, Cynthia B
AU  - Spiegel, Brennan M R
AU  - Feagan, Brian
AU  - Sands, Bruce
AU  - Loftus, Edward V
AU  - Panaccione, Remo
AU  - D'Haens, Geert
AU  - Bernstein, Charles N
AU  - Gearry, Richard
AU  - Ng, Siew C
AU  - Mantzaris, Gerassimos J
AU  - Sartor, Balfour
AU  - Silverberg, Mark S
AU  - Riddell, Robert
AU  - Koutroubakis, Ioannis E
AU  - O'Morain, Colm
AU  - Lakatos, Peter L
AU  - McGovern, Dermot P B
AU  - Halfvarson, Jonas
AU  - Reinisch, Walter
AU  - Rogler, Gerhard
AU  - Kruis, Wolfgang
AU  - Tysk, Curt
AU  - Schreiber, Stefan
AU  - Danese, Silvio
AU  - Sandborn, William
AU  - Griffiths, Anne
AU  - Moum, Bjorn
AU  - Gasche, Christoph
AU  - Pallone, Francesco
AU  - Travis, Simon
AU  - Panes, Julian
AU  - Colombel, Jean-Frederic
AU  - Hanauer, Stephen
AU  - Peyrin-Biroulet, Laurent
TI  - Development of an index to define overall disease severity in IBD
AID  - 10.1136/gutjnl-2016-312648
DP  - 2018 Feb 01
TA  - Gut
PG  - 244--254
VI  - 67
IP  - 2
4099  - http://gut.bmj.com/content/67/2/244.short
4100  - http://gut.bmj.com/content/67/2/244.full
SO  - Gut2018 Feb 01; 67
AB  - Background and aim Disease activity for Crohn's disease (CD) and UC is typically defined based on symptoms at a moment in time, and ignores the long-term burden of disease. The aims of this study were to select the attributes determining overall disease severity, to rank the importance of and to score these individual attributes for both CD and UC.Methods Using a modified Delphi panel, 14 members of the International Organization for the Study of Inflammatory Bowel Diseases (IOIBD) selected the most important attributes related to IBD. Eighteen IOIBD members then completed a statistical exercise (conjoint analysis) to create a relative ranking of these attributes. Adjusted utilities were developed by creating proportions for each level within an attribute.Results For CD, 15.8% of overall disease severity was attributed to the presence of mucosal lesions, 10.9% to history of a fistula, 9.7% to history of abscess and 7.4% to history of intestinal resection. For UC, 18.1% of overall disease severity was attributed to mucosal lesions, followed by 14.0% for impact on daily activities, 11.2% C reactive protein and 10.1% for prior experience with biologics. Overall disease severity indices were created on a 100-point scale by applying each attribute's average importance to the adjusted utilities.Conclusions Based on specialist opinion, overall CD severity was associated more with intestinal damage, in contrast to overall UC disease severity, which was more dependent on symptoms and impact on daily life. Once validated, disease severity indices may provide a useful tool for consistent assessment of overall disease severity in patients with IBD.