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Applicability of endoscopic indices in the determination of disease activity in patients with ulcerative colitis

Kucharski, Marcin; Karczewski, Jacek; Mańkowska-Wierzbicka, Dorota; Karmelita-Katulska, Katarzyna; Grzymisławski, Marian; Kaczmarek, Elżbieta; Iwanik, Katarzyna; Rzymski, Piotr; Swora-Cwynar, Ewelina; Linke, Krzysztof; Dobrowolska, Agnieszka

European Journal of Gastroenterology & Hepatology: June 2016 - Volume 28 - Issue 6 - p 722–730
doi: 10.1097/MEG.0000000000000601
Original Articles: Inflammatory Bowel Disease

Objective The combination of clinical remission and mucosal healing represents a major goal of different treatment strategies for ulcerative colitis (UC). This study aimed to assess which of the endoscopic indices used to evaluate mucosal changes in UC are correlated with clinical indices currently used to determine disease activity, as well as which of the endoscopic indices are correlated with the Geboes Index used for histological evaluation. It also aimed to find correlations between the currently used clinical activity indices and the histological Geboes Index.

Methods A group of 49 patients with a confirmed diagnosis of UC and a group of 52 individuals without a diagnosis of gastrointestinal disease, who constituted the control group, were investigated. All patients were evaluated by colonoscopy, and the severity of mucosal changes was scored in terms of nine different endoscopic indices commonly used in both pharmacological trials and clinical practice. Evaluation was also carried out using clinical and histological indices. Endoscopic indices used for UC were then correlated with different clinical and histological indices to find the strongest correlations.

Results and conclusion A high correlation was demonstrated between three of the 11 evaluated clinical indices – Improvement Based on Individual Symptom Scores, Ulcerative Colitis Disease Activity Index, and Schroeder Index – and all nine endoscopic indices – Ulcerative Colitis Endoscopic Index of Severity, Baron Score, Schroeder Index, Feagan Index, Powell–Tuck Index, Rachmilewitz Index, Sutherland Index, Lofberg Index, and Lemman Index. Improvement Based on Individual Symptom Scores was the index with the highest correlation with all the endoscopic indices used for UC. The above indices are recommended for clinical evaluation of UC activity. The Ulcerative Colitis Endoscopic Index of Severity was moderately correlated with a histological index, and it is therefore recommended for routine endoscopic mucosal evaluation in patients with UC.

Departments of aGastroenterology, Human Nutrition and Internal Diseases

bEnvironmental Medicine

cGeneral Radiology

dInternal Diseases, Metabolism and Nutrition

eBioinformatics and Computational Biology

fClinical Pathology, Poznan University of Medical Sciences, Poznan, Poland

Correspondence to Jacek Karczewski, Poznan University of Medical Sciences, Fredry 10, 61-701 Poznan, Poland Tel: +48 608 648 523; fax: +48 618 794 150;e-mail:

Received October 31, 2015

Accepted January 12, 2016

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.