title: Novel endoscopic activity index is useful for choosing treatment in severe active ulcerative colitis patients.
abstract: OBJECTIVE
  Clinical symptoms are the most important factors used by physicians to evaluate the severity and extent of ulcerative colitis (UC). In this context, colonoscopy is also a useful diagnostic tool. We have recently developed an endoscopic activity index (EAI) to assess the severity of UC. Here, we assess the correlations among the EAI, other endoscopic indices, and clinical scores. The usefulness of the EAI for choosing treatment options, such as intravenous corticosteroid or cyclosporine A (CsA), in severe UC patients was also evaluated.
  
  
  METHODS
  Clinical symptoms and endoscopic finding were evaluated in 396 patients with UC (454 colonoscopies). The EAI was scored using the following six items: ulcer size, ulcer depth, redness, bleeding, edema, and mucus exudates. The patients were also scored using Matts' grade, Rachmilewitz's endoscopic index, and the Lichtiger index.
  
  
  RESULTS
  Our results showed that (1) the EAI scores were closely correlated with those of the Lichtiger index, Matts' grade, and Rachmilewitz's endoscopic index; (2) the EAI scores significantly decreased in patients who responded to treatment, while Matts' grade did not change in some responders treated with intravenous CsA and steroid; (3) patients with a higher EAI (14-16) tended to be refractory to corticosteroid therapy (responders 19%) compared to CsA (77%), while steroid treatment was effective in 58% of patients with EAI scores of 11-13.
  
  
  CONCLUSIONS
  The EAI is equivalent to other endoscopic indices and relatively more useful in choosing a treatment for patients with severe UC.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Naganuma
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ichikawa
authors.forename: Nagamu
authors.initials: N
authors.lastname: Inoue
authors.forename: Taku
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Susumu
authors.initials: S
authors.lastname: Okamoto
authors.forename: Tadakazu
authors.initials: T
authors.lastname: Hisamatsu
authors.forename: Takanori
authors.initials: T
authors.lastname: Kanai
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Ogata
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Iwao
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Hibi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D003113:Colonoscopy / Q000379:methods*; D016572:Cyclosporine / Q000627:therapeutic use*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016572:Cyclosporine
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