title: Review article: the histological assessment of disease activity in ulcerative colitis.
abstract: BACKGROUND
  In patients with ulcerative colitis (UC), mucosal healing has emerged as a major therapeutic goal, and is usually assessed endoscopically. Histological healing does not correlate very well with endoscopic mucosal healing in UC and persistent histological inflammation might be a better predictor of future clinical relapse than the endoscopic appearance alone.
  
  
  OBJECTIVE
  To define how histological assessment of disease activity should be best done in UC.
  
  
  METHODS
  Electronic (PubMed/Embase) and manual search.
  
  
  RESULTS
  At least 18 histological indices to assess disease activity in UC have been described, though none are fully validated. However, histological assessment is increasingly used as a secondary endpoint in clinical trials in UC. After reviewing and discussing existing histological scoring systems for UC activity, we describe features of histological response and define three grades of activity: (i) histological healing - complete resolution of abnormalities; (ii) quiescent disease, - lack of mucosal neutrophils but chronic inflammation may remain; (iii) active disease - presence of neutrophils plus possible epithelial damage. It is recommended that two biopsies are taken from each colonic segment which should include always biopsy of the rectum and the most affected segments. There is to date no agreed preferable scoring system but the Geboes Index is the best validated (kappa for interobserver variation 0.59-0.70).
  
  
  CONCLUSIONS
  Histological assessment of disease activity in UC is increasingly used, but needs to be carefully defined.
authors: Department of Pathology, University Hospital of Reims, Reims, France.
authors: A
authors: A
authors: Marchal Bressenot
authors: Deparment of Pathology and Laboratory Medicine, Mt Sinai Hospital, Toronto, ON, Canada.
authors: R H
authors: RH
authors: Riddell
authors: Department of Pathology, University Hospital of Reims, Reims, France.
authors: C
authors: C
authors: Boulagnon-Rombi
authors: Division of Gastroenterology, Department of Internal Medicine, McMaster University, Hamilton, ON, Canada.
authors: W
authors: W
authors: Reinisch
authors: Department of Gastroenterology, IBD Center, Humanitas Research Hospital, Rozzano, Milan, Italy.
authors: S
authors: S
authors: Danese
authors: Department Medicine I, University-Hospital Schleswig-Holstein, Kiel, Germany.
authors: S
authors: S
authors: Schreiber
authors: Inserm U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Lorraine Univeristy, Vandoeuvre-lès-Nancy, France.
authors: L
authors: L
authors: Peyrin-Biroulet
mesh_terms: D001706:Biopsy; D003093:Colitis, Ulcerative / Q000473:pathology*; D018450:Disease Progression; D006652:Histological Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000473:pathology; D012008:Recurrence; D012107:Research Design; D014945:Wound Healing