title: Understanding Endoscopic Disease Activity in IBD: How to Incorporate It into Practice.
abstract: Endoscopic assessment of disease activity is an essential part of clinical practice in inflammatory bowel disease (IBD) and is used for diagnosis, prognosis, monitoring for dysplasia and increasingly for the evaluation of mucosal or endoscopic response to therapy. Recently, mucosal or endoscopic healing has emerged as a key goal of therapy as it has been found that patients who achieve endoscopic remission have improved outcomes compared to those who do not, and this may be independent of their clinical disease activity. However, there is currently no validated definition of mucosal healing and there are numerous endoscopic scoring systems proposed to define endoscopic activity and response to therapy in both ulcerative colitis and Crohn's disease. This article will discuss the most common endoscopic scores used to measure endoscopic disease activity in IBD, the pros and cons of each of these scoring systems and proposed definitions for endoscopic response or remission that exist for each. In addition, the role of endoscopy in prognosticating the disease course is discussed and how endoscopy can be utilized as part of a "treat-to-target" treatment strategy where endoscopy results direct decisions regarding medical strategies in clinical practice is highlighted.
authors.affiliation: University of Chicago Medicine Inflammatory Bowel Disease Center, 5841 S. Maryland Ave., MC4076, Room M410, Chicago, IL, 60637, USA.|Department of Gastroenterology, Alfred Hospital and Monash University, Melbourne, Australia.
authors.forename: Britt
authors.initials: B
authors.lastname: Christensen
authors.affiliation: University of Chicago Medicine Inflammatory Bowel Disease Center, 5841 S. Maryland Ave., MC4076, Room M410, Chicago, IL, 60637, USA. drubin@medicine.bsd.uchicago.edu.
authors.forename: David T
authors.initials: DT
authors.lastname: Rubin
mesh_terms: D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D003424:Crohn Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D007413:Intestinal Mucosa / Q000502:physiology; D012720:Severity of Illness Index; D014945:Wound Healing / Q000502:physiology
keywords: Colonoscopy; Crohn’s disease; Disease activity indices; Endoscopic disease activity; Inflammatory bowel disease; Mucosal activity; Mucosal healing; Ulcerative colitis