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P111. “EARS” (Erlanger Activity Related Score) of IBD: A new tool that allows accurate in vivo assessment of inflammatory activity in ulcerative colitis


H. Neumann1, M. Vieth2, M. Waldner1, R. Atreya1, J. Mudter1, M. Grauer1, C. Günther1, M. Neurath1

1University of Erlangen-Nuremberg, Department of Medicine 1, Erlangen, Germany; 2Klinikum Bayreuth, Institute of Pathology, Bayreuth, Germany



Background: Precise activity assessment of inflammatory activity is of crucial importance to predict disease outcome and therapeutic efficacy in ulcerative colitis (UC). Confocal laser endomicroscopy (CLE) was recently introduced as a new emerging endoscopic imaging modality enabling to obtain images of the cellular and subcellular layer at a magnification of about 1000-fold. Aim was to develop a new and simplified classification system that allows real time in vivo assessment of inflammatory activity in UC using CLE.

Methods: Overall, 36 consecutive patients with UC and 18 control patients who underwent total colonoscopy with CLE were included. Inflammatory activity was assessed by the Mayo UC endoscopic score and with CLE using the “EARS of IBD” scoring system. Afterwards biopsies were taken for additional histologic grading. The “EARS of IBD” consists of two parameters: (1) leakage intensity, graded as 1 (weak), 2 (moderate), and 3 (strong) and (2) proportion of microvessels which was classified as 1 (<10%), 2 (11–50%), 3 (51–80%) and 4 (>80%). The final score represents the product of intensity x proportion ranging from 1 to 12. In order to validate the score complex computerized imaging methods (ImageJ, NIH, USA) were used to calculate vessel density and leakage according to standardized criteria.

Results: The “EARS of IBD” showed excellent correlation with the computerized measurement of inflammation activity (Spearman's rho, P < 0.05). Moreover, the “EARS of IBD” was able to detect inflammatory activity even in the case of macroscopically uneventful mucosa. Therefore, in more than half of patients with normal mucosa, the “EARS of IBD” revealed acute inflammation (P < 0.05). When comparing CLE findings of inflammatory activity with histological results a strong correlation was found (Spearman's rho, P < 0.05).

Conclusions: The “EARS of IBD” was established as a new and simplified classification system for real time in vivo assessment on inflammatory activity in patients with UC. Interestingly, the classification system could even predict acute inflammation in the case of macroscopically non-inflamed mucosa.