It has been validated by rigorous methodology and it has high inter-observer agreement. 30 This index is calculated by a formula that includes four different variables (granularity, vascular pattern, ulceration and bleeding–friability), all of them scored in each of the five segments (rectum, sigmoid, descending, transverse and ascending). So far, the only endoscopic index taking into account all the colonic segments is the Ulcerative Colitis Colonoscopic Index of Severity (UCCIS), developed in 2013 by Samuel et al. The UCEIS, as well as the previous endoscopic scores, is based on the macroscopic evaluation of the most severely involved colon segment and does not take into account the extent of UC involvement. 29 This index grades three endoscopic findings, namely vascular pattern, bleeding and erosions/ulcers, into different levels of severity with precise definitions. Recently, the Ulcerative Colitis Endoscopic Index of Severity (UCEIS, nine-point scale) has been developed based on the intra- and inter-observer variability of 10 endoscopic descriptors. None of the aforementioned endoscopic scores has been validated. 25 Partly due to its simplicity, the MES is the most commonly used endoscopic activity index in clinical trials for evaluating treatment efficacy in terms of endoscopic improvement. The MES (four-point scale) was developed in 1987 by Schroeder et al. In contrast, the modified Baron score (five-point scale) 28 and the Rachmilewitz endoscopic index (12-point scale) 27 were developed to incorporate the vascular pattern, as well as the presence of granularity, hyperaemia, friability, bleeding and ulcerations. In the Baron score (four-point scale), 23 the Powel–Tuck index (Saint Mark’s index, three-point scale) 24 and the endoscopic subscore of the Sutherland index (UC disease activity index, four-point scale), 26 the degree of endoscopic disease activity is mainly based on the severity of mucosal friability and bleeding, while the presence of mucosal ulcerations is not included. These include the Baron score, 23 the Powell–Tuck index, 24 the MES, 25 the Sutherland index 26 and the Rachmilewitz index, 27 most of them sharing similar endoscopic variables. The first endoscopic scores were developed to assess the severity but not the extent of endoscopic activity in ulcerative colitis. 2, 14–22 Secondly, patients may present with patchy healing (especially those on topical treatment) however, at present there are no data on the outcomes of this partial MH. Although different endoscopic scores have been used to define MH, 7–13 the Mayo endoscopic subscore (MES) of 0 or 1 has been one of the most used definitions. Moreover, no validated definition of MH currently exists in the literature. Firstly, many different endoscopic scores exist. 6 However, there are several limitations with an endoscopy-based approach to treatment. 1–5 Recently, endoscopic assessment has been demonstrated to be a feasible and more beneficial strategy than clinical assessment to guide treatment optimization in UC patients. The presence of MH has been demonstrated to decrease the risk of relapse, hospitalizations, colorectal cancer and colectomy. Mucosal healing (MH) has become an important goal in the treatment of ulcerative colitis (UC). Endoscopic scores, ulcerative colitis, disease extent 1.
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