Newer ulcerative colitis score outperforms traditional score

By David Douglas

The recently developed Ulcerative Colitis Endoscopic Index of Severity (UCEIS) may more accurately reflect clinical outcomes and long-term prognosis than the long-established Mayo Endoscopic Score (ES), according to Japanese investigators.

In a November 18 online paper in the Journal of Crohn's and Colitis, Dr. Hiroyuki Hanai of Hamamatsu South Hospital and colleagues note that an ES of 0 or 1 is a widely accepted criterion for mucosal healing (MH), both in trials and in clinical practice.

The team used both the ES and the UCEIS to evaluate 41 patients with UC who had colonoscopies before and after tacrolimus remission induction therapy.

The Mayo ES is divided into four strata, and to aid comparison the researchers employed four measures of UCEIS scoring ranging from remission (0 to 1) through mild (2 to 4) and moderate (5 to 6) to severe (7 to 8).

The mean UCEIS improved from 6.2 to 3.4. Both the response and the remission groups reached a significant level of change. In contrast, the Mayo ES did not show significant change in the response group.

It appears that the ulcers became smaller and shallower during the earlier stages of mucosal healing but the Mayo ES did not reflect this.

Thus, say the researchers, "the Mayo ES does not distinguish deep ulcers from shallow ulcers, and remains 3 (severe UC). In contrast, the descriptor of erosions and ulcers in the UCEIS is improved from 3 to 2."

In addition, because bleeding is clearly defined in the UCEIS scoring system, "the score reflects improvement of endoscopic appearance reliably, but the Mayo ES does not."

Overall, say the investigators, "UCEIS score reflects the true clinical outcomes after a medical intervention, very much better than the Mayo ES does."

Further investigations in larger cohorts, they conclude, "are warranted to fully reveal the limitations of the Mayo ES."

Commenting by email, gastroenterologist Dr. Jean-Frederic Columbel told Reuters Health, "This study is part of ongoing efforts to define what is the best endoscopy scoring system in (inflammatory bowel disease)."

Dr. Columbel, who is professor of medicine at Mount Sinai Hospital, New York, added, "This is becoming more and more important since endoscopy is now part of primary endpoints for clinical trials and also used in clinical practice as a new therapeutic target. This study suggests that the new UCEIS endoscopic index is more responsive than the Mayo Clinic endoscopy subscore. However this is a rather small series and needs to be confirmed."

Dr. Hanai did not respond to requests for comments.

SOURCE: http://bit.ly/1NZUzqs

J Crohns Colitis 2015.

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