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Defining a Flare in IBD
Researchers in Canada found that a single-item patient self-report indicator was able to identify symptomatic flares of disease among patients with inflammatory bowel disease (IBD) when compared to other measures of disease activity.
“Flare is a poorly defined term used by patients and clinicians to indicate inflammatory bowel disease (IBD) status,” the authors wrote in the journal Inflammatory Bowel Disease. “This study aimed to evaluate the validity of relative to other measures of disease flare.”
In the longitudinal Manitoba Living with IBD Study, patients with IBD completed biweekly online surveys and provided 3 stool samples during the 1-year study period. The team developed a a single-item indicator with 7 possible responses that patients used to report their as “moderately” or “much” worse.
The researchers evaluated the flare indicator against 5 measures of disease activity: fecal calprotectin score (FCAL); the IBD Symptom Index short form (SIBDSI); the short form IBD Questionnaire (SIBDQ); a 2-point disease status indicator; and a 4-point flare certainty indicator. Participants whose 7-point measure indicated a disease activity flare were matched to a nonflaring participant, and a stool sample was collected.
“Of the 155 IBD participants, almost half (n = 74) experienced a flare. Of those who flared, 97.0% endorsed active IBD on the 2-point indicator (controls 42.5%; P < .001); 91.9% endorsed active IBD on the 4-point certainty indicator (controls 32.9%; P < .001); 90.5% endorsed active disease on the SIBDSI (controls 34.2%; P < .001); and 48.5% had an elevated FCAL (controls 34.3%; P < .05),” the investigators reported. “The mean SIBDQ was lower for the flare group compared with controls (43.9 [SD 11.1] vs 58.3 [SD 8.5]; P < .001), indicating worse disease.”
The authors concluded, “The 7-point flare indicator robustly identified symptomatic flares. This patient self-report indicator reflected meaningful changes in more complex clinical indices and had only weak concordance with the presence of inflammation.”
—Rebecca Mashaw
Reference:
Witges K, Sexton K, Graff LA, et al. What is a flare? The Manitoba Living With IBD study. Inflamm Bowel Dis. 2022;28(6): 862–869. https://doi.org/10.1093/ibd/izab192
