Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
s_assessdt
Item
Date of assessment
date
Item
Since the last visit documented in the database were there any visits that were not captured?
integer
Code List
Since the last visit documented in the database were there any visits that were not captured?
s_visitnotcap
Item
Number of visits not captured
integer
s_entry
Item
Current visit data entered by
text
s_primprov
Item
Primary Attending Gastroenterologist
text
s_secprov
Item
Secondary provider
text
Item Group
Colectomy/Ostomy
Item
Has the patient had a colectomy? (If Yes, and the patient's diagnosis is UC, the patient should be inactivated)
integer
Code List
Has the patient had a colectomy? (If Yes, and the patient's diagnosis is UC, the patient should be inactivated)
s_colectomydt
Item
Date of colectomy
date
Item
Does the Patient currently have an ileostomy or colostomy?
integer
Code List
Does the Patient currently have an ileostomy or colostomy?
Item
What is the patient's current diagnosis?
integer
Code List
What is the patient's current diagnosis?
CL Item
Crohn's Disease (1)
CL Item
Ulcerative Colitis (2)
CL Item
Indeterminate Colitis (3)
Item Group
In the following set of questions, describe the symptoms on the worst day in the last 7 days
Item
General well-being related to IBD
integer
Code List
General well-being related to IBD
CL Item
Don't Know/Not Assessed (6)
Item
Limitations in daily activities related to IBD
integer
Code List
Limitations in daily activities related to IBD
CL Item
Don't Know/Not Assessed (4)
Item
Abdominal pain due to IBD
integer
Code List
Abdominal pain due to IBD
CL Item
Moderate to Severe (6)
CL Item
Don't Know/Not Assessed (5)
Item Group
In the following set of questions, describe the patient's stools on the worst day in the last 7 days
s_totstool
Item
Total number of stools per day (enter 0 if none)
integer
s_totstool not assessed
Item
Not Assessed
boolean
Item
Most stools were
integer
Code List
Most stools were
CL Item
Partially Formed (2)
CL Item
Don't Know/Not Assessed (4)
s_liquidstool
Item
Number of liquid/watery stools per day (enter 0 if none)
integer
s_liquidstool not assessed
Item
Not Assessed
boolean
Item
Did the patient report bloody stools?
integer
Code List
Did the patient report bloody stools?
Item
If blood was present, the typical amount was
integer
Code List
If blood was present, the typical amount was
CL Item
Small amount in less than 50% of stools (5)
CL Item
Small amount in greater than 50% of stools (6)
CL Item
Not available/assessed (4)
Item
Nocturnal diarrhea
integer
Code List
Nocturnal diarrhea
CL Item
Not available/assessed (2)
Item Group
Extraintestinal Manifestations
Item
Fever 38.5 degrees C (101.3 degrees F) for 3 of last 7 days?
integer
Code List
Fever 38.5 degrees C (101.3 degrees F) for 3 of last 7 days?
CL Item
Not available/assessed (2)
Item
Definite arthritis?
integer
Code List
Definite arthritis?
CL Item
Not available/assessed (2)
CL Item
Not available/assessed (2)
Item
Erythema nodosum?
integer
Code List
Erythema nodosum?
CL Item
Not available/assessed (2)
Item
Pyoderma gangrenosum?
integer
Code List
Pyoderma gangrenosum?
CL Item
Not available/assessed (2)
Item
Abdominal exam
integer
CL Item
No tenderness, no mass (1)
CL Item
Mild tenderness or questionable mass without tenderness (2)
CL Item
Moderate to severe tenderness, involuntary guarding, definite mass (3)
Item
Perirectal disease at current exam
integer
Code List
Perirectal disease at current exam
CL Item
Normal or asymptomatic tag, non-draining fistula without tenderness, no deep fissuring or abscess (1)
CL Item
Mildly inflamed skin tag(s), 1 to 2 indolent fistulas with scant drainage (NO tenderness, deep fissures or abscess (2)
CL Item
Severely inflamed tag(s), active fistula with drainage, tenderness, abscess, or deep fissure (3)
Item
Current Height: Unit
text
Code List
Current Height: Unit
s_ht
Item
Current Height
integer
s_ht not assessed
Item
Not Assessed
boolean
Item
Current Weight: Unit
text
Code List
Current Weight: Unit
s_wt
Item
Current Weight
float
s_wt not assessed
Item
Not Assessed
boolean
s_bmi
Item
Current BMI
float
Item
For patients less than 18 years old, has height, weight and BMI been plotted on a growth chart?
integer
Code List
For patients less than 18 years old, has height, weight and BMI been plotted on a growth chart?
Item Group
Disease Assessment
Item
Physicians Global Assessment of current disease status
integer
Code List
Physicians Global Assessment of current disease status
CL Item
Don't Know/Not Assessed (5)
Item Group
Extent of Disease: Crohn's Disease/Indeterminate Colitis patients only (select one for each category)
Item
Macroscopic Lower GI Disease?
integer
Code List
Macroscopic Lower GI Disease?
Item
Macroscopic Upper GI Disease proximal to the ligament of Treitz?
integer
Code List
Macroscopic Upper GI Disease proximal to the ligament of Treitz?
Item
Macroscopic Upper GI Disease distal to the ligament of Treitz?
integer
Code List
Macroscopic Upper GI Disease distal to the ligament of Treitz?
Item
For CD/IC patients only: Current Crohn's Disease Phenotype
integer
Code List
For CD/IC patients only: Current Crohn's Disease Phenotype
CL Item
Inflammatory, non-penetrating, non-stricturing (1)
CL Item
Both Stricturing and Penetrating (4)
Item
For CD/IC patients only: Perianal Phenotype?
integer
Code List
For CD/IC patients only: Perianal Phenotype?
Item Group
Extent of Disease: Ulcerative Colitis subjects only
Item
Extent of Disease: Ulcerative Colitis subjects only
integer
Code List
Extent of Disease: Ulcerative Colitis subjects only
CL Item
Ulcerative Proctitis (rectum only (1)
CL Item
Left sided Ulcerative Colitis (2)
CL Item
Extensive Ulcerative Colitis (3)
CL Item
Pancolitis (the entire colon (4)
CL Item
Not assessed completely (5)
Item
For UC patients only: Ulcerative Colitis Behavior: Has the patient ever had severe disease?
integer
Code List
For UC patients only: Ulcerative Colitis Behavior: Has the patient ever had severe disease?
Item Group
Nutritional and Growth Status
Item
Nutritional Status
integer
Code List
Nutritional Status
Item
For patients less than 18 years old: Growth Status
integer
Code List
For patients less than 18 years old: Growth Status
Item
Since the last visit, has the patient been in continuous remission?
integer
Code List
Since the last visit, has the patient been in continuous remission?
Item
Since the last visit, has the patient had a serious infection? (Note: A serious infection is one that requires hospitalization or IV therapy)
integer
Code List
Since the last visit, has the patient had a serious infection? (Note: A serious infection is one that requires hospitalization or IV therapy)
s_infecy
Item
If yes, indicate infection
text
Item
Are there psychosocial risk factors that are felt to significantly impact the patient's medical care?
integer
Code List
Are there psychosocial risk factors that are felt to significantly impact the patient's medical care?
Item Group
Laboratory Analysis
Item
Was a blood sample drawn for laboratory analysis?
integer
Code List
Was a blood sample drawn for laboratory analysis?
s_lbdt
Item
Date of lab sample
date
Item
C-Reactive Protein
integer
Code List
C-Reactive Protein
CL Item
Done on same date as above (1)
CL Item
Done on different date than above (2)
s_crpdt
Item
Date of sample
date
s_crpunkn
Item
Outside quantifiable range
boolean
Item
If result is outside the quantifiable range, select one:
integer
Code List
If result is outside the quantifiable range, select one:
CL Item
Below level of quantification (1)
CL Item
Above level of quantification (2)
CL Item
Done on same date as above (1)
CL Item
Done on different date than above (2)
s_hemdt
Item
Hematocrite Date of sample
date
s_esrunkn
Item
Outside quantifiable range
boolean
Item
If result is outside the quantifiable range, select one
integer
Code List
If result is outside the quantifiable range, select one
CL Item
Below level of quantification (1)
CL Item
Above level of quantification (2)
CL Item
Done on same date as above (1)
CL Item
Done on different date than above (2)
s_albdt
Item
Date of sample
date
Item
Is the patient currently taking any non-biologic prescription medications for IBD?
integer
Code List
Is the patient currently taking any non-biologic prescription medications for IBD?
Item Group
Aminosalicylates
sulfataking
Item
Sulfasalazine
boolean
s_azuldose
Item
Dose
integer
Item
New Medication Today?
integer
Code List
New Medication Today?
Item
If No, started:
integer
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
penttaking
Item
Pentasa
boolean
s_pentdose
Item
Dose
integer
Item
New Medication Today?
integer
Code List
New Medication Today?
Item
If No, started:
integer
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
asataking
Item
Asacol
boolean
s_asadose
Item
Dose
integer
Item
New Medication Today?
integer
Code List
New Medication Today?
Item
If No, started:
integer
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
aprtaking
Item
Apriso
boolean
s_aprisodose
Item
Dose
integer
Item
New Medication Today?
integer
Code List
New Medication Today?
Item
If No, started:
integer
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
liataking
Item
Lialda
boolean
s_lialdadose
Item
Dose
integer
Item
New Medication Today?
integer
Code List
New Medication Today?
Item
If No, started:
integer
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
colataking
Item
Colazal
boolean
s_coladose
Item
Dose
integer
Item
New Medication Today?
integer
Code List
New Medication Today?
Item
If No, started:
integer
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
delztaking
Item
Delzicol
boolean
s_delzdose
Item
Dose
integer
Item
New Medication Today?
integer
Code List
New Medication Today?
Item
If No, started:
integer
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
Item Group
Rectal Therapy
Item
Is the patient taking any rectal therapy?
integer
Code List
Is the patient taking any rectal therapy?
rwstaking
Item
Rowasa
boolean
s_rowasadose
Item
Dose
integer
Item
New Medication Today?
integer
Code List
New Medication Today?
Item
If No, started:
integer
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
cantaking
Item
Canasa
boolean
s_canasadose
Item
Dose
integer
Item
New Medication Today?
integer
Code List
New Medication Today?
Item
If No, started:
integer
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
hdrtaking
Item
Hydrocortisone enema/suppository
boolean
s_hydrocortdose
Item
Dose
text
Item
New Medication Today?
integer
Code List
New Medication Today?
Item
If No, started:
integer
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
Item Group
Corticosteroids
Item
Is the patient taking any corticosteroids?
integer
Code List
Is the patient taking any corticosteroids?
pdstaking
Item
Prednisone
boolean
s_preddose
Item
Dose
integer
Item
New Medication Today?
integer
Code List
New Medication Today?
Item
If No, started:
integer
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
bdstaking
Item
Budesonide
boolean
s_budedose
Item
Dose
integer
Item
New Medication Today?
integer
Code List
New Medication Today?
Item
If No, started:
integer
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
mpredtaking
Item
Methylprednisolone
boolean
s_mpreddose
Item
Dose
integer
Item
New Medication Today?
integer
Code List
New Medication Today?
Item
If No, started:
integer
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
Item Group
Immunomodulators
Item
Is the patient taking any immunomodulators?
integer
Code List
Is the patient taking any immunomodulators?
6mptaking
Item
6MP
boolean
s_6mpdose
Item
Dose
integer
Item
New Medication Today?
integer
Code List
New Medication Today?
Item
If No, started:
integer
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
azataking
Item
Azathioprine
boolean
s_azadose
Item
Dose
integer
Item
New Medication Today?
integer
Code List
New Medication Today?
Item
If No, started:
integer
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
alptaking
Item
Allopurinol
boolean
s_allopdose
Item
Dose
integer
Item
New Medication Today?
integer
Code List
New Medication Today?
Item
If No, started:
integer
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
mthtaking
Item
Methotrexate
boolean
s_methdose
Item
Dose
integer
Item
New Medication Today?
integer
Code List
New Medication Today?
Item
If No, started:
integer
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
Item
Methotrexate Route
integer
Code List
Methotrexate Route
folictaking
Item
Folic Acid
boolean
s_folicdose
Item
Dose
integer
Item
New Medication Today?
integer
Code List
New Medication Today?
Item
If No, started:
integer
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
Item Group
Other Immune Suppressants
Item
Is the patient taking cyclosporine or tacrolimus?
integer
Code List
Is the patient taking cyclosporine or tacrolimus?
cyclotaking
Item
Cyclosporine
boolean
s_cyclodose
Item
Dose
integer
Item
New Medication Today?
integer
Code List
New Medication Today?
Item
If No, started:
integer
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
tacrotaking
Item
Tacrolimus
boolean
s_tacrodose
Item
Dose
integer
Item
New Medication Today?
integer
Code List
New Medication Today?
Item
If No, started:
integer
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
Item Group
Antibiotics for IBD
Item
Is the patient taking any antibiotic for IBD?
integer
Code List
Is the patient taking any antibiotic for IBD?
ciprotaking
Item
Cipro
boolean
s_ciprodose
Item
Dose
integer
Item
New Medication Today?
integer
Code List
New Medication Today?
Item
If No, started:
integer
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
flagltaking
Item
Flagyl
integer
s_flagldose
Item
Dose
integer
Item
New Medication Today?
integer
Code List
New Medication Today?
Item
If No, started:
integer
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
rifaxtaking
Item
Rifaximin
boolean
s_rifaxdose
Item
Dose
integer
Item
New Medication Today?
integer
Code List
New Medication Today?
Item
If No, started:
integer
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
Item Group
Biologics Information
Item
Since the last visit, was an induction dose given for any biologic?
integer
Code List
Since the last visit, was an induction dose given for any biologic?
fidt
Item
Date of first induction dose
date
Item
Which biologic was initiated at this induction dose?
integer
Code List
Which biologic was initiated at this induction dose?
Item Group
Reasons for initiation of biologics (*Note: these questions will only appear for new biologic agents)
Item
Steroid dependence?
integer
Code List
Steroid dependence?
Item
Toxicity of Immunomodulator?
integer
Code List
Toxicity of Immunomodulator?
Item
Lack of response to immunomodulator?
integer
Code List
Lack of response to immunomodulator?
Item
Failure of other biologic?
integer
Code List
Failure of other biologic?
Item
Growth failure?
integer
Code List
Growth failure?
Item
Perianal disease?
integer
Code List
Perianal disease?
Item
Severity of endoscopic findings?
integer
Code List
Severity of endoscopic findings?
Item
Postsurgical prophylaxis?
integer
Code List
Postsurgical prophylaxis?
Item
No other treatment attempted?
integer
Code List
No other treatment attempted?
othspecify
Item
Specify
text
Item Group
Biologic regimen following today's visit, starting with next dose
infmabtaking
Item
Remicade
boolean
s_inflixcurrdose
Item
Dose
integer
Item
Treatment Period
integer
Code List
Treatment Period
s_inflixcurrenterval
Item
Dosing Interval (for maintenance medications only)
integer
cimztaking
Item
Cimzia
boolean
s_cimziacurrdose
Item
Dose
integer
Item
Treatment Period
integer
Code List
Treatment Period
s_cimziacurrinterval
Item
Dosing Interval (for maintenance medications only)
integer
humrtaking
Item
Humira
boolean
s_humiracurrdose
Item
Dose
integer
Item
Treatment Period
integer
Code List
Treatment Period
s_humiracurrinterval
Item
Dosing Interval (for maintenance medications only)
integer
tysataking
Item
Tysabri
boolean
s_tysabricurrdose
Item
Dose
integer
Item
Treatment Period
integer
Code List
Treatment Period
s_tysabricurrinterval
Item
Dosing Interval (for maintenance medications only)
integer
simptaking
Item
Simponi
boolean
s_simpdose
Item
Dose
integer
Item
Treatment Period
integer
Code List
Treatment Period
s_simpdi
Item
Dosing Interval (for maintenance medications only)
integer
steltaking
Item
Stelera
boolean
s_steldose
Item
Dose
integer
Item
Treatment Period
integer
Code List
Treatment Period
s_steldi
Item
Dosing Interval (for maintenance medications only)
integer
entyvtaking
Item
Entyvio
boolean
s_entyvdose
Item
Dose
integer
Item
Treatment Period
integer
Code List
Treatment Period
s_entyvdi
Item
Dosing Interval (for maintenance medications only)
integer
Item Group
Other prescription medications for IBD (per site discretion)
othmedtaking
Item
Medication
text
othmeddose
Item
Dose
integer
Item
New Medication today?
integer
Code List
New Medication today?
Item
If No, started:
integer
Code List
If No, started:
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
Item Group
Is the patient currently taking the following?
Item
An enteral caloric intake supplement?
integer
Code List
An enteral caloric intake supplement?
Item
Enteral nutrition as primary therapy?
integer
Code List
Enteral nutrition as primary therapy?
Item
If Yes, when was enteral therapy started?
integer
Code List
If Yes, when was enteral therapy started?
CL Item
Less than 1 month ago (1)
CL Item
More than 1 month ago (0)
Item
Is enteral therapy being used generally based on the ICN protocol?
integer
Code List
Is enteral therapy being used generally based on the ICN protocol?
Item
Has the TPMT been measured?
integer
Code List
Has the TPMT been measured?
Item
TPMT Genotype
integer
CL Item
Homozygous recessive (3)
s_tpmtgenodt
Item
TPMT Genotype date
date
Item
TPMT Phenotype
integer
s_tpmtphenodt
Item
TPMT Phenotype date
date
Item
Has the patient had 6MP metabolites measured more recently than the test indicated above?
integer
Code List
Has the patient had 6MP metabolites measured more recently than the test indicated above?
s_thiometabdt
Item
If Yes, most recent measurement date
date
s_6tgn
Item
Most recent 6-TGN level
text
6tgunkn
Item
Outside quantifiable range
boolean
Item
If result is outside the quantifiable range, select one:
integer
Code List
If result is outside the quantifiable range, select one:
CL Item
Below level of quantification (1)
CL Item
Above level of quantification (2)
s_6mmpn
Item
Most recent 6-MMPN
text
6mpunkn
Item
Outside quantifiable range
boolean
Item
If result is outside the quantifiable range, select one:
integer
Code List
If result is outside the quantifiable range, select one:
CL Item
Below level of quantification (1)
CL Item
Above level of quantification (2)
Item Group
Remicade, Humira, Cimzia, Tysabri Patients
Item
If a chest x-ray has been done more recently than the test indicated above, please provide the result
integer
Code List
If a chest x-ray has been done more recently than the test indicated above, please provide the result
s_cxrposneg
Item
Date of last CXR
date
Item
If a PPD has been placed more recently than the test indicated above, please provide the result
integer
Code List
If a PPD has been placed more recently than the test indicated above, please provide the result
s_ppdposneg
Item
Date of last PPD
date
Item
Quantiferon Gold test
integer
Code List
Quantiferon Gold test
CL Item
Indeterminate (2)
goldtestdt
Item
Date of last Quantiferon Gold test
date
Item Group
Remicade Patients
Item
Has the patient had Remicade trough level measured more recently than the test above?
integer
Code List
Has the patient had Remicade trough level measured more recently than the test above?
s_inflixtrough
Item
Remicade trough level
text
Item
If result is outside the quantifiable range, select one:
integer
Code List
If result is outside the quantifiable range, select one:
CL Item
Below level of quantification (0)
CL Item
Above level of quantification (1)
s_inflixtroughdt
Item
Date of Remicade trough level measurement
date
Item
Remicade Trough Lab?
integer
Code List
Remicade Trough Lab?
CL Item
LabCorp (Esoterix (1)
Item
Has the patient had Remicade antibody levels measured more recently than the test above?
integer
Code List
Has the patient had Remicade antibody levels measured more recently than the test above?
s_inflixantibody
Item
Remicade antibody level
text
Item
If result is outside the quantifiable range, select one:
integer
Code List
If result is outside the quantifiable range, select one:
CL Item
Below level of quantification (0)
CL Item
Above level of quantification (1)
s_inflixantibodydt
Item
Date of Remicade antibody level measurement
date