@article{06b50472dae44765a0f0ade95aab3f62,
title = "Histopathology Scoring Systems of Stenosis Associated With Small Bowel Crohn's Disease: A Systematic Review",
abstract = "Background & Aims: Stenosis is a common complication of Crohn's disease (CD) that has no effective medical therapy. Development of antifibrotic 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 semiquantitative 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 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 individual. All scores fitting the criteria were included in our analysis, independent 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 the scoring systems, which were not derived from 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 the development of evaluative indices. Basic knowledge regarding their operating properties were lacking. Specific indices for evaluating the important pathologic 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.",
keywords = "Fibrosis, Histopathology, IBD, Stricture",
author = "{Stenosis Therapy and Anti-Fibrotic Research (STAR) Consortium} and Gordon, {Ilyssa O.} and Dominik Bettenworth and Arne Bokemeyer and Amitabh Srivastava and Christophe Rosty and {de Hertogh}, Gert and Robert, {Marie E.} and Valasek, {Mark A.} and Ren Mao and Satya Kurada and Noam Harpaz and Paula Borralho and Pai, {Reetesh K.} and Pai, {Rish K.} and Robert Odze and Roger Feakins and Parker, {Claire E.} and Tran Nguyen and Vipul Jairath and Baker, {Mark E.} and Bruining, {David H.} and Fletcher, {J. G.} and Feagan, {Brian G.} and Florian Rieder",
note = "Funding Information: Funding This work was supported by the Helmsley Charitable Trust through the Stenosis Therapy and Anti-Fibrotic Research (STAR) Consortium. Conflicts of interest These authors disclose the following: Ilyssa O. Gordon receives no direct support; however, the Cleveland Clinic receives support for her from UCB, Celgene, and Pliant Therapeutics. Dominik Bettenworth is on the advisory board or consultant for Amgen, AbbVie, Dr Falk Foundation, Ferring, MSD Sharp & Dohme Gmbh, Pfizer, Pharmacosmos, Roche, Takeda, Tillotts Pharma, and Vifor. Gert de Hertogh has received consulting fees from GlaxoSmithKline, Shire Pharmaceuticals, Teva Pharma, Galapagos, Genentech, Novartis Pharma, Fast Forward Pharmaceuticals, Takeda, and Janssen R&D and University Hospital Leuven has received support for her from Centocor and Takeda. Marie E. Robert has served on the speaker's panel for Merck; as a pathologist on a clinical trial for Bayer; and as chief scientific officer of Beyond Celiac, a nonprofit patient support organization, outside of the submitted work. Satya Kurada is supported by National Institute of Health grant 5T32DK083251-08. Noam Harpaz is a consultant for AbbVie, Celgene, and Lilly USA. Paula Borralho reports personal fees from MSD, personal fees from Roche, and personal fees from AstraZeneca, outside the submitted work. Rish K. Pai has received consulting fees from Seres Therapeutics, Genentech, Eli Lilly, Protagonist, Arena, and Gossamer Bio. Claire E. Parker and Tran Nguyen are employees of Robarts Clinical Trials, Inc. Vipul Jairath receives salary support from the John and Susan McDonald Endowed IBD Chair at Western University, London, Ontario, Canada; consulting fees from AbbVie, Eli Lilly, GlaxoSmithKline, Arena Pharmaceuticals, Genentech, Pendopharm, Sandoz, Merck, Takeda, Janssen, Robarts Clinical Trials, Topivert, and Celltrion; and speaker's fees from Takeda, Janssen, Shire, Ferring, AbbVie, and Pfizer. Mark E. Baker receives no direct support; however, the Cleveland Clinic receives support for him from Siemens Healthineers in the form of salary, software, and hardware for the investigation of reduced exposure in computed tomography enterography. David H. Bruining is a consultant for and receives research support from Medtronics. J.G. Fletcher receives grants to his institution from Siemens Healthineers and Medtronic. Brian G. Feagan has received grant/research support from Millennium Pharmaceuticals, Merck, Tillotts Pharma AG, AbbVie, Novartis Pharmaceuticals, Centocor Inc, Elan/Biogen, UCB Pharma, Bristol-Myers Squibb, Genentech, ActoGeniX, and Wyeth Pharmaceuticals Inc.; consulting fees from Millennium Pharmaceuticals, Merck, Centocor Inc., Elan/Biogen, Janssen-Ortho, Teva Pharmaceuticals, Bristol-Myers Squibb, Celgene, UCB Pharma GmbH Pharma, AbbVie, AstraZeneca, Serono, Genentech, Tillotts Pharma AG, Unity Pharmaceuticals, Albireo Pharma, Given Imaging Inc, Salix Pharmaceuticals, Novo Nordisk, GlaxoSmithKline, ActoGeniX, Prometheus Therapeutics and Diagnostics, Athersys, Axcan, Gilead, Pfizer, Shire, Wyeth, Zealand Pharma, Zyngenia, GiCare Pharma Inc, and Sigmoid Pharma; and speaker's bureau fees from UCB, AbbVie, and Johnson & Johnson/Janssen. Florian Rieder is on the advisory board or is a consultant for AbbVie, Allergan, Celgene, Gossamer, Receptos, Thetis, UCB, Samsung, Koutif, Pliant, Boehringer Ingelheim, Metacrine, Takeda, Allergan, Helmsley, RedX, Gilead, and Roche. The remaining authors disclose no conflicts.",
year = "2020",
month = jan,
doi = "10.1053/j.gastro.2019.08.033",
language = "English (US)",
volume = "158",
pages = "137--150.e1",
journal = "Gastroenterology",
issn = "0016-5085",
publisher = "W.B. Saunders Ltd",
number = "1",
}