Mayo Endoscopic Score and Ulcerative Colitis Endoscopic Index Are Equally Effective for Endoscopic Activity Evaluation in Ulcerative Colitis Patients in a Real Life Setting

Cristiano Pagnini,Lorella Pallotta,Benedetta Maria Mariani,Maria Giovanna Graziani,Riccardo Urgesi,Lucia D’Alba,Emilio Di Giulio,Mario Alessandro Vitale,Maria Carla Di Paolo,Maria Assunta De Cesare,Giuseppe Villotti

doi:10.3390/gastroent12020019

Abstract

The role of endoscopic evaluation in ulcerative colitis (UC) is well recognized, but a universally accepted gold standard for endoscopic activity evaluation is still lacking, and many scores have been proposed to this purpose. Among these, the Mayo Endoscopic Score (MES) and the Ulcerative Colitis Endoscopic Index (UCEIS) are currently the most used in trials and clinical practice. The aim of the study is to evaluate feasibility and performance of MES and UCEIS among expert endoscopists with no specific expertise in inflammatory bowel diseases (IBD), in a single hospital center. Two minutes video recordings, from colonoscopy of 12 UC patients, were observed and scored, according to MES and UCEIS, by seven hospital gastroenterologists with experience in digestive endoscopy and no particular expertise in IBD. Knowledge and utilization of the two scores were investigated. Inter-observer agreement and agreement with an IBD-expert gastroenterologist of the same center (central reader), and correlation between the two scores, was calculated. Among the endoscopists, MES was much more known and currently used than UCEIS. Both the scores displayed a similar good performance. Agreement with central reader was moderate for MES and UCEIS, and interobserver agreement was good, for both MES and UCEIS. Correlation between the two scores was very good both for central reader and for the hospital endoscopists. This single center study confirmed potential feasibility and usefulness of MES and UCEIS for assessment of endoscopic activity in UC patients in a real-life setting.

Highlights

Ulcerative colitis (UC) is a chronic inflammatory disease that affects the colonic mucosa, involving the rectum and proximally extending throughout the colon to a variable degree
Recent findings in geographic trends seem to question the previously observed north–south gradient, for UC incidence is rising in countries such as Asia and North Africa, in parallel with the industrialization and “westernization” of these areas [2]
The profound effect of such drugs at the mucosal level has pushed forward the concept that the healing of the colonic mucosa, confirmed by endoscopic examination, should represent a more solid end-point to achieve in UC patients

Summary

Introduction

Ulcerative colitis (UC) is a chronic inflammatory disease that affects the colonic mucosa, involving the rectum and proximally extending throughout the colon to a variable degree. It is clinically characterized by a relapsing and remitting course with symptoms like bloody diarrhea, abdominal pain and loss of weight during flare periods [1]. Since the etiology of the disease is still unknown, no curative therapy exists Current approved treatments, such as mesalamine, corticosteroids, immunomodulatory drugs (immunosuppressant, biologic drugs, small molecules), are directed to control the inflammatory burden, with the final goal of inducing and maintaining remission. Double-blind, placebo-controlled, multicenter study investigating the safety and efficacy of a delayed-released mesalamine formulation in UC patients, final results profoundly changed after endoscopic reports’ revision by expert central readers [8]

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Results