title: The Modified Mayo Endoscopic Score (MMES): A New Index for the Assessment of Extension and Severity of Endoscopic Activity in Ulcerative Colitis Patients.
abstract: OBJECTIVE
  Current endoscopic activity scores for ulcerative colitis (UC) do not take into account the extent of mucosal inflammation. We have developed a simple endoscopic index for UC that takes into account the severity and distribution of mucosal inflammation.
  
  
  METHODS
  In this multicentre trial, UC patients undergoing colonoscopy were prospectively enrolled. For the Modified Score (MS), the sum of Mayo Endoscopic Subscores (MESs) for five colon segments (ascending, transverse, descending, sigmoid and rectum) was calculated. The Extended Modified Score (EMS) was obtained by multiplying the MS by the maximal extent of inflammation. The Modified Mayo Endoscopic Score (MMES) was obtained by dividing the EMS by the number of segments with active inflammation. Colon biopsies were obtained from the rectum and sigmoid, as well as from all inflamed segments, by standard methods. Clinical activity was scored according to the Partial Mayo Score (PMS). Biological activity was scored according to C-reactive protein (CRP) and faecal calprotectin (FC) levels. Histological activity was scored according to the Geboes Score (GS).
  
  
  RESULTS
  One hundred and seventy-one UC patients (38% female, median age 47 years, median disease duration 13 years) were included. The MMES correlated significantly with the PMS (r = 0.535), CRP (r = 0.238), FC (r = 0.730) and GS (r = 0.615) (all p < 0.001). Median MMES scores were significantly higher in patients with clinical, biological or histological activity (all p ≤ 0.001) CONCLUSIONS: The MMES is an easy to use endoscopic index for UC that combines the severity analysis of the MES with disease extent, and correlates very well with clinical, biological and histological disease activity.
authors.affiliation: Department of Gastroenterology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
authors.forename: Triana
authors.initials: T
authors.lastname: Lobatón
authors.affiliation: Department of Gastroenterology, Royal Victoria Hospital, Montreal, Quebec, Canada.
authors.forename: Talat
authors.initials: T
authors.lastname: Bessissow
authors.affiliation: Department of Pathology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
authors.forename: Gert
authors.initials: G
authors.lastname: De Hertogh
authors.affiliation: Department of Pathology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
authors.forename: Bart
authors.initials: B
authors.lastname: Lemmens
authors.affiliation: Department of Pathology, Royal Victoria Hospital, Montreal, Quebec, Canada.
authors.forename: Chelsea
authors.initials: C
authors.lastname: Maedler
authors.affiliation: Department of Gastroenterology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
authors.forename: Gert
authors.initials: G
authors.lastname: Van Assche
authors.affiliation: Department of Gastroenterology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
authors.forename: Séverine
authors.initials: S
authors.lastname: Vermeire
authors.affiliation: Department of Gastroenterology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
authors.forename: Raf
authors.initials: R
authors.lastname: Bisschops
authors.affiliation: Department of Gastroenterology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
authors.forename: Paul
authors.initials: P
authors.lastname: Rutgeerts
authors.affiliation: Department of Gastroenterology, Royal Victoria Hospital, Montreal, Quebec, Canada.
authors.forename: Alain
authors.initials: A
authors.lastname: Bitton
authors.affiliation: Department of Gastroenterology, Royal Victoria Hospital, Montreal, Quebec, Canada.
authors.forename: Waqqas
authors.initials: W
authors.lastname: Afif
authors.affiliation: Department of Pathology, Royal Victoria Hospital, Montreal, Quebec, Canada.
authors.forename: Victoria
authors.initials: V
authors.lastname: Marcus
authors.affiliation: Department of Gastroenterology, University Hospitals Leuven, KU Leuven, Leuven, Belgium. marc.ferrante@uzleuven.be.
authors.forename: Marc
authors.initials: M
authors.lastname: Ferrante
mesh_terms: D000328:Adult; D002097:C-Reactive Protein / Q000378:metabolism; D003093:Colitis, Ulcerative / Q000378:metabolism / Q000473:pathology*; D003113:Colonoscopy; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D039841:Leukocyte L1 Antigen Complex / Q000378:metabolism; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D039841:Leukocyte L1 Antigen Complex; D002097:C-Reactive Protein
keywords: Endoscopic scores; disease extent; ulcerative colitis