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A validated scoring tool, EASE-CD, showed strong accuracy and reliability in quantifying ulcer activity in Crohn’s disease.  

Researchers conducted a retrospective study published in June 2025 issue of Lancet Gastroenterology and Hepatology to develop and validate a new endoscopic index for Crohn’s disease addressing limitations of existing scoring systems.  

They evaluated paired baseline and post-induction ileocolonoscopy videos from a phase 3b adalimumab trial (NCT00348283; n = 112) and a phase 2 risankizumab trial (NCT02031276; n = 99). Multiple central readers, masked to treatment and clinical data, assessed the videos using candidate endoscopic items identified through modified RAND/UCLA appropriateness methods, 4 readers scored all 112 videos, and 2 readers reassessed 44 post-treatment videos to evaluate inter-rater reliability. Items with an intraclass correlation coefficient (ICC) ≥ 0.41 and win probability (WinP) ≥ 0.56 were selected as covariates for regression modeling. Internal validation was performed using bootstrapping, and external validation was conducted using the risankizumab trial dataset.  

The results showed that 10 endoscopic items met the ICC and WinP criteria for inclusion in model development. These included items from SES-CD, CDEIS, and exploratory lesion-based variables. The final model, named Endoscopic Ulcer Activity Score for Evaluating Crohn’s disease (EASE-CD), incorporated ulcer presence and size (ordinal scale 0–3), deep ulceration (binary 0 or 1), and ulcerated surface area (continuous scale 0–1), averaged across bowel segments, with total scores ranging from 0 to 100. Internal validation showed r² = 0.608 and optimism-adjusted r² = 0.554, with calibration slope 0.983. External validation yielded adjusted r² = 0.565 and slope 0.997, EASE-CD demonstrated strong inter-rater reliability (ICC 0.798 [95% CI 0.711–0.836]) and high responsiveness (WinP 0.769 [95% CI 0.658–0.851]; P< 0.001). A 10-point reduction in EASE-CD predicted endoscopic response with 82.4% specificity (95% CI 78.6–86.0) and 69.9% sensitivity (95% CI 63.3–76.4). An EASE-CD score of 0 indicated ulcer-free endoscopic remission.  

Investigators concluded that EASE-CD was a validated, reliable, and treatment-responsive continuous index for measuring endoscopic ulcer activity in Crohn’s disease. 

Source: thelancet.com/journals/langas/article/PIIS2468-1253(25)00093-7/abstract