November 2017

Standardized Assessment Tools for Pediatric IBD patients

Use these reference tools to classify the disease type and extent and with measuring disease activity in

the pediatric patient with inflammatory bowel disease.

Pediatric Crohn’s Disease Activity Index (PCDAI)

Pediatric Crohn’s Disease Activity Index (PCDAI): Validated instrument for measuring disease activity in

children and adolescents with Crohn’s disease. Disease activity is determined as a numerical score based

on evaluation of:

Abdominal pain

Number of stools per day

Weight

Linear growth

Physical findings

o Abdominal pain

o Perianal disease

o Extra-intestinal manifestations

Laboratory studies

o Hemoglobin/Hematocrit

o ESR

o Albumin

Functioning and general well-being ( 1 week recall)

Score ranges from 0 to 100

0 – 10 Inactive disease

10 – 30 Mild disease

>30 Moderate to severe disease

References

Hyams JS, Ferry GD, Mandel FS, Gryboski JD, Kibort, PM, Kirschner BS, Griffiths AM, Katz, AJ, Grand RJ, Boyle, JT,

Michener WM ,Levy JS & Lesser ML (1991). Development and Validation of a Pediatric Crohn’s Disease Activity

Index. Journal of Pediatric Gastroenterology and Nutrition. (12): 439 – 447.

Loonen HJ, Griffiths AM, Merkus MP & Derkx HH. (2003) A Critical Assessment of Items on the Pediatric Crohn’s

Disease Activity Index. Journal of Pediatric Gastroenterology and Nutrition (36): 90 – 95.

Hyams J, Markowitz J, Otley A, Rosh J, Mack D, Bousvaros A, Kugathasan S, Pfefferkorn M, Tolia V, Evans J,

Treem W, Wyllie R, Rothbaum R, del Rosario J, Katz A, Mezoff A, Oliva-Hemker M, Lerer T, and Griffiths A (

2005). Evaluation of the Pediatric Crohn Disease Activity Index: A Prospective Multicenter Experience. Journal of

Pediatric Gastroenterology and Nutrition (41): 416 – 421.

November 2017

Pediatric Ulcerative Colitis Activity Index (PUCAI)

Pediatric Ulcerative Colitis Activity Index (PUCAI) - Validated instrument for measuring disease activity in

children and adolescents with Ulcerative Colitis. Disease activity is determined as a numerical score

based on evaluation of:

Abdominal pain

Number of stools per day

Stool consistency

Amount of blood in stools

Nocturnal stooling

Activity level

Score ranges from 0 to >85.

0 – 9 Inactive disease

10 -34 Mild disease

35 – 64 Moderate disease

65 – 85 Severe disease

References

Turner, D, Otley, AR, Mack D, Hyams, J, De Bruijne, J, Uusoue K, Walters TD, Zachos M, Mamula P, Beaton,

DE, Steinhart, AH, Griffiths, AM (2007). Development, validation, and Evaluation of a Pediatric Ulcerative

Colitis Activity Index: A Prospective Multicenter Study. Gastroenterology (133): 423 - 432.

Full article: http://www.gastrojournal.org/article/S0016-5085(07)01011-6/pdf

Appendix:

http://download.lww.com/wolterskluwer_vitalstream_com/PermaLink/MPG/A/MPG_2011_04_25_LEE_2017

08_SDC1.pdf

Request permissions:

https://s100.copyright.com/AppDispatchServlet?publisherName=ELS&contentID=S0016508507010116&order

BeanReset=true&orderSource=Phoenix

Turner D, Hyams J , Markovitz J, Lerer T, Mack DR, Evans J, Pfefferkorn M, Rosh J, Kay K, Crandall W,

Keljo D, Otley AR, Kugathasan S, Carvalho R, Oliva-Hemker M, Langton C, Mamula P, Bousvaros A,

Leleiko N & Griffiths, AM (2009). Appraisal of the Pediatric Ulcerative Colitis Activity Index (PCUAI).

Inflammatory Bowel Disease. (15): 1218-1223.

https://www.ncbi.nlm.nih.gov/pubmed/19161178

November 2017

Paris Criteria

Paris Criteria - A modification of the Montreal Criteria used in defining disease location and behavior.

The Paris Criteria takes into account:

Age of diagnosis

Extent of disease (location)

Phenotype (behavior)

Growth

Age of diagnosis is categorized as: Birth up to 10 years of age 10 up to 17 years of age 17 – 40 years of age Greater than 40 years of age

Extent of disease

Crohn’s disease or Indeterminate Colitis

The extent of disease is based on : o Macroscopic findings of ulcerations or erosions seen on endoscopic evaluation

o Evidence of small bowel disease found on video capsule, radiographic and/or nuclear

medicine studies.

*The extent of disease is always the worst that was ever documented.

The phenotype for Crohn’s Disease or Indeterminate Colitis describes the behavior of the disease. It is documented as o Inflammatory o Stricturing

o Penetrating

o Both penetrating and stricturing disease.

o The presence or absence of perianal involvement

Ulcerative Colitis

o The extent of disease is based

o Macroscopic findings of ulcerations or erosions seen on endoscopic evaluation

Ulcerative proctitis Left-sided disease (distal to splenic flexure only) Extensive disease (distal to hepatic flexure) Pancolitis (proximal to hepatic flexure)

*The extent of disease is always the worst that was ever documented.

November 2017

o Phenotype (Severity) of Ulcerative Colitis is based on PUCAI score and ) is documented as

Remission (less than 10)

Mild (10 – 34)

Moderate (35 – 64)

Severe disease greater than ≥ 65

Growth

o No evidence of growth delay

o Evidence of growth delay

Reference

Levine A, Griffiths A, Markowitz J, Wilson DC, Turner D, Russell RK, Fell, J, Ruemmele FM, Walters T,

Sherlock M, Dubinski M, & Hyams JS. (2011) Pediatric Modification of the Montreal Classification for

Inflammatory Bowel Disease: The Paris Classification. Inflammatory Bowel Disease (17) 6: 1314 -1321.

Full article: http://www.naspghan.org/files/documents/pdfs/training/curriculum-

resources/ibd/Paris_Classification.pdf