Intest Res.  2018 Oct;16(4):579-587. 10.5217/ir.2018.00021.

Patient self-reported symptoms using visual analog scales are useful to estimate endoscopic activity in ulcerative colitis

• Tsuda S
• Kunisaki R
• Kato J
• Murakami M
• Nishio M
• Ogashiwa T
• Yoshida T
• Kimura H
• Kitano M

• KMID: 2434160
• DOI: http://doi.org/10.5217/ir.2018.00021

Abstract

BACKGROUND/AIMS
In clinical practice, colonoscopy has been regarded as the gold standard for the evaluation of disease severity as well as mucosal healing in ulcerative colitis (UC). Some activity indices incorporating patient symptoms as parameters have been shown to reflect the endoscopic activity of UC. The aim of this study was to examine whether self-reported symptoms with visual analog scales (VAS) can predict endoscopic activity.
METHODS
A cross-sectional study of 150 UC patients who underwent colonoscopy with submission of VAS scores of 4 symptoms: general condition, bloody stools, stool form, and abdominal pain (0: no symptoms, 10: the most severe symptoms). Each VAS score was compared with colonoscopic activity assessed with the Mayo endoscopic subscore (MES).
RESULTS
All VAS scores were significantly correlated with the endoscopic severity (Spearman correlation coefficients of general condition, bloody stools, stool form, and abdominal pain: 0.63, 0.64, 0.58, and 0.43, respectively). Mucosal healing defined as MES 0 alone was predicted by VAS score < 1.5 on general condition or 0 on bloody stools with sensitivity of 0.84 and 0.76 and specificity of 0.66 and 0.76, respectively. Additionally, VAS score < 2.5 on stool form predicted active lesions in distal colorectum alone with sensitivity of 0.67 and specificity of 0.66, suggesting that this item could predict the indication of topical therapy.
CONCLUSIONS
Self-reported VAS scores on symptoms were correlated with endoscopic activity of UC. To clarify the relationship between VAS and mucosal healing, further validation studies are needed.

Keyword

Colitis, ulcerative; Endoscopic mucosal healing; Visual analog scale

MeSH Terms

Abdominal Pain
Colitis, Ulcerative*
Colonoscopy
Cross-Sectional Studies
Humans
Sensitivity and Specificity
Ulcer*
Visual Analog Scale*

Figure

• 

  Fig. 1. Correlation between visual analog scale (VAS) scores for each symptom and colonoscopic severities in the UC patients. The VAS score of each item was positively correlated with colonoscopic activity assessed with the Mayo endoscopic subscore (Spearman correlation coefficient of general condition, bloody stools, stool form, and abdominal pain: 0.63, 0.64, 0.58 and 0.43, respectively, P-values for all items <0.001).

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