Copyright ©The Author(s) 2016.
World J Gastroenterol. Nov 14, 2016; 22(42): 9324-9332
Published online Nov 14, 2016. doi: 10.3748/wjg.v22.i42.9324
Table 1 Disease activity indices with endoscopic component alone
Disease activity indexEndoscopic variables
Baron score[14]Bleeding and MVP
Rachmilewitz endoscopic index[18]Granulation, MVP, Mucosal vulnerability, Mucosal damage
UC colonoscopic index of severity (UCCIS)[19]MVP, Granularity, Ulceration, Bleeding, Segmental assessment of endoscopic severity, Global assessment of endoscopic severity
UC endoscopic index of severity (UCEIS)[13]MVP, Bleeding, Erosions and Ulcers
Table 2 Disease activity indices with endoscopic and non-endoscopic components
Disease activity indexEndoscopic variablesNon-endoscopic variable
Powell-Tuck score[20]BleedingWellbeing, Abdominal pain, stool frequency and consistency, Bleeding, Anorexia, nausea and vomiting, EIM, Temperature
Sutherland index[21]Friability, BleedingStool frequency, Bleeding, Physician’s rating of disease activity
Mayo score[16]Erythema, MVP, Friability, erosions, ulcers, spontaneous bleedingStool frequency, Bleeding, Physician’s global assessment
Improvement based on individual symptom scores[22]Mucosal oedema, MVP, Granularity, Friability, Petechiae, Ulceration, Spontaneous bleedingRectal bleeding, Stool frequency, Abdominal pain, PFA, PGA
Table 3 Correlation of endoscopic activity with clinical symptoms
Ref.Study characteristicsResults
Karoui et al[35]Prospective observational study.CRP correlated well with DAI and Rachmilewitz score
2011101 patients with UC in remission.Correlation between DAI and Rachmilewitz was not statistically significant
TunisiaCRP, Disease activity index and Rachmilewitz scores used
Osada et al[36]Prospective observational study.Clinical symptoms correlated with left sided disease activity.
200854 patients with UC.CRP and ESR correlated well with right sided inflammation.
JapanCRP, ESR, Mayo endoscopic subscore, Lichtiger’s clinical activity scores used.
Turner et al[37]Prospective observational study.Disease activity was best assessed by Walmsley and PUCAI followed by Partial Mayo score and Rachmilewitz
200986 patients with UC. Disease activity was measured using 9 different activity indices
Table 4 Correlation between white light endoscopy and histology in ulcerative colitis
Ref.Study characteristics and aimsResults
Bitton et al[8]Prospective observational study36.4% patients relapsed
200174 patients in clinical and endoscopic remission were includedYounger age, multiple previous relapses (women), and basal plasmacytosis on histology predicted relapse.
United StatesFollowed up for a year or until the patients relapsed.CRP, ESR, IL-1b, -6, 15, ANCA was non-predictive of relapse.
Azad et al[41]Prospective observational study57.7% patients relapsed
201126 patients with clinical and endoscopic remission were includedIncreased Eosinophils and Neutrophils were predictors of relapse.
IndiaMonthly follow up for a year or until the patients relapsed.Hb, CRP, ESR, IL-6 were not predictive of relapse.
Bessissow et al[7]Retrospective studyMicroscopic inflammation was found in 40% of patients.
201275 patients with endoscopically inactive disease (Mayo score 0)Basal plasmacytosis and histological activity (Geboes score ≥ 3.1) predicted relapse.
BelgiumTime to relapse was noted
Lemmens et al[40]Retrospective studySignificant correlation with Mayo endoscopic subscore and histology noted in extremes of disease (inactive and acute severe disease)
2013131 patients with known UC
BelgiumCorrelation of endoscopy and histology
Rosenberg et al[5]Prospective observational study54% of patients with quiescent disease had signs of histological inflammation.
2013103 UC patients in clinical remission
United StatesCorrelation of endoscopy and histology
Feagins et al[6]Retrospective study of 51 patients.20% of patients had flare up within 12 mo.
2013colonoscopy for surveillanceBasal lymphocytosis, disruption of crypt architecture, erosions and ulcers predicted relapse.
United StatesCorrelation of endoscopic and histological activity
Zenlea et al[42]Prospective study23% of patients relapsed
2016179 patients includedHistological activity with Geboes score ≥ 3.1 was strongest predictor of relapse.
United StatesBaseline Mayo endoscopic score and Geboes score for histology noted
Follow up period was 12 mo
Table 5 Relapse prediction using advanced imaging techniques
Ref.Imaging modalityStudy characteristicsResults
Watanabe et al[9]Magnification colonoscopy with chromoendoscopyProspective study70% of patients with mucosal defects identified by MC had a flare up within 12 mo
200957 patients with clinical and endoscopic remission were enrolled for MC examination and followed up for 12 mo
Nishio et al[10]Magnification colonoscopy with chromoendoscopyProspective study29% of patients relapsed. Significant correlation seen between pit pattern abnormalities and relapse rate.
2006113 patients with UC in remission were enrolled. Pit pattern in rectal mucosa assessed using MC. Followed up for 12 mo
Fujiya et al[11]Magnification colonoscopy18 patients with UC in remission underwent MC and follow up7 out of 9 (77.7%) with minute epithelial defect had a flare.
Kudo et al[46]NBIProspective studyObscured MVP had good correlation with the histological activity.
2009157 colonic segments among 30 patients were examined under WLE and NBI
Jauregui-Amezaga et al[49]Chromoendoscopy and NBIProspective study27% relapsed during follow up
201464 patients with clinical and endoscopic remission for at least 3 mo were included. 1 year follow up.Neither NBI nor chromoendoscopy predicted relapse
Osada et al[55]AFIRetrospective studyThe green component of AFI correlated closely with the inflammatory activity
2011572 images from 42 patients were correlated with histological activity