RT Journal Article
SR Electronic
T1 International consensus to standardise histopathological scoring for small bowel strictures in Crohn’s disease
JF Gut
JO Gut
FD BMJ Publishing Group Ltd and British Society of Gastroenterology
SP 479
OP 486
DO 10.1136/gutjnl-2021-324374
VO 71
IS 3
A1 Ilyssa O Gordon
A1 Dominik Bettenworth
A1 Arne Bokemeyer
A1 Amitabh Srivastava
A1 Christophe Rosty
A1 Gert de Hertogh
A1 Marie E Robert
A1 Mark A Valasek
A1 Ren Mao
A1 Jiannan Li
A1 Noam Harpaz
A1 Paula Borralho
A1 Reetesh K Pai
A1 Robert Odze
A1 Roger Feakins
A1 Claire E Parker
A1 Leonardo Guizzetti
A1 Tran Nguyen
A1 Lisa M Shackelton
A1 William J Sandborn
A1 Vipul Jairath
A1 Mark Baker
A1 David Bruining
A1 Joel G Fletcher
A1 Brian G Feagan
A1 Rish K Pai
A1 Florian Rieder
A1 ,
YR 2022
UL http://gut.bmj.com/content/71/3/479.abstract
AB Objective Effective medical therapy and validated trial outcomes are lacking for small bowel Crohn’s disease (CD) strictures. Histopathology of surgically resected specimens is the gold standard for correlation with imaging techniques. However, no validated histopathological scoring systems are currently available for small bowel stricturing disease. We convened an expert panel to evaluate the appropriateness of histopathology scoring systems and items generated based on panel opinion.Design Modified RAND/University of California Los Angeles methodology was used to determine the appropriateness of 313 candidate items related to assessment of CD small bowel strictures.Results In this exercise, diagnosis of naïve and anastomotic strictures required increased bowel wall thickness, decreased luminal diameter or internal circumference, and fibrosis of the submucosa. Specific definitions for stricture features and technical sampling parameters were also identified. Histopathologically, a stricture was defined as increased thickness of all layers of the bowel wall, fibrosis of the submucosa and bowel wall, and muscularisation of the submucosa. Active mucosal inflammatory disease was defined as neutrophilic inflammation in the lamina propria and any crypt or intact surface epithelium, erosion, ulcer and fistula. Chronic mucosal inflammatory disease was defined as crypt architectural distortion and loss, pyloric gland metaplasia, Paneth cell hyperplasia, basal lymphoplasmacytosis, plasmacytosis and fibrosis, or prominent lymphoid aggregates at the mucosa/submucosa interface. None of the scoring systems used to assess CD strictures were considered appropriate for clinical trials.Conclusion Standardised assessment of gross pathology and histopathology of CD small bowel strictures will improve clinical trial efficiency and aid drug development.Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.