Validation of the “German Inflammatory Bowel Disease Activity Index (GIBDI)”: An Instrument for Patient-Based Disease Activity Assessment in Crohn’s Disease and Ulcerative Colitis

Abstract

Introduction Assessment of disease activity in Crohn’s disease (CD) and ulcerative colitis (UC) is usually based on the physician’s evaluation of clinical symptoms, endoscopic findings, and biomarker analysis. The German Inflammatory Bowel Disease Activity Index for CD (GIBDI_CD) and UC (GIBDI_UC) uses data from patient-reported questionnaires. It is unclear to what extent the GIBDI agrees with the physicians’ documented activity indices.

Methods Data from 2 studies were reanalyzed. In both, gastroenterologists had documented disease activity in UC with the partial Mayo Score (pMS) and in CD with the Harvey Bradshaw Index (HBI). Patient-completed GIBDI questionnaires had also been assessed. The analysis sample consisted of 151 UC and 150 CD patients. Kappa coefficients were determined as agreement measurements.

Results Rank correlations were 0.56 (pMS, GIBDI_UC) and 0.57 (HBI, GIBDI_CD), with p < 0.001. The absolute agreement for 2 categories of disease activity (remission yes/no) was 74.2 % (UC) and 76.6 % (CD), and for 4 categories (none/mild/moderate/severe) 60.3 % (UC) and 61.9 % (CD). The kappa values ranged between 0.47 for UC (2 categories) and 0.58 for CD (4 categories).

Discussion There is satisfactory agreement of GIBDI with the physician-documented disease activity indices. GIBDI can be used in health care research without access to assessments of medical practitioners. In clinical practice, the index offers a supplementary source of information.

Zusammenfassung

Einleitung Die Bestimmung der Krankheitsaktivität bei Morbus Crohn (MC) und Colitis ulcerosa (CU) stützt sich meist auf Arzturteile, endoskopische Befunde oder Biomarker-Analysen. Der German Inflammatory Bowel Disease Activity Index für MC (GIBDI_MC) und CU (GIBDI_CU) nutzt patientenberichtete Fragebogendaten. Unklar ist, inwieweit der GIBDI mit ärztlicherseits dokumentierten Aktivitätsindizes übereinstimmt.

Methodik Daten aus 2 Studien wurden reanalysiert. In beiden dokumentierten Gastroenterologen die Krankheitsaktivität bei CU mit dem partial Mayo Score (pMS), bei MC mit dem Harvey Bradshaw Index (HBI). Patienten bearbeiteten den GIBDI. Die Analysestichprobe bildeten 151 CU- und 150 MC-Patienten. Als Übereinstimmungsmaße wurden Kappa-Koeffizienten bestimmt.

Ergebnisse Es zeigen sich Rangkorrelationen von 0.56 (pMS, GIBDI_CU) und 0.57 (HBI, GIBDI_MC), jeweils p < 0.001. Die absolute Übereinstimmung bei zwei Kategorien der Krankheitsaktivität (Remission ja/nein) ist 74,2 % (CU) bzw. 76,6 % (MC), bei vier Kategorien (keine/leichte/mittlere/schwere) 60,3 % (CU) bzw. 61,9 % (MC). Die Kappa-Werte liegen zwischen 0,47 bei CU (zwei Kategorien) und 0,58 bei MC (vier Kategorien).

Diskussion Der GIBDI zeigt eine zufriedenstellende Übereinstimmung mit den ärztlich dokumentierten Aktivitätsindizes. Sein Einsatz bietet sich in Versorgungsforschungsstudien ohne Zugang zu Urteilen ärztlicher Behandler an. In der klinischen Praxis lässt sich der Index als ergänzende Informationsquelle nutzen.

Key words

Crohn’s disease - ulcerative colitis - German Inflammatory Bowel Disease Activity Index (GIBDI) - Harvey Bradshaw Index (HBI) - partial Mayo Score (pMS)

Schlüsselwörter

Morbus Crohn - Colitis ulcerosa - German Inflammatory Bowel Disease Activity Index (GIBDI) - Harvey Bradshaw Index (HBI) - partial Mayo Score (pMS)

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