Measuring certain areas involved in ulcerative colitis (UC) over time can help monitor for signs of improved disease, known as endoscopic improvement.
Doctors, researchers, and other healthcare professionals use different forms of measurement to determine if a person with UC is showing signs of improvement. One such measure is endoscopic improvement.
This article reviews what endoscopic improvement means, how doctors measure it, and how a person can achieve it.
It involves measurements or scoring performed by a person’s doctor or healthcare team immediately following an endoscopic evaluation. These measurements are then tracked over time to determine if the disease is improving or worsening.
There are a few ways to measure endoscopic improvement:
Mayo Endoscopic Score
The MES measures mucosal inflammation found during an endoscopy on the following
- 0 = normal
- 1 = erythema, decreased vascular pattern, and mild friability
- 2 = marked erythema, absent vascular pattern, friability, and erosions
- 3 = ulceration and spontaneous bleeding
The lower the MES score, the better.
A lower MES score is
- need for a colectomy, which is a surgical procedure
However, researchers note
While the researchers also note that this scoring system is easy to use and produces mostly repeatable results, they suggest other tools may better show incremental healing that the current forms of measurement do not accurately show. Other tools, such as the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) score, are more accurate and may show better incremental healing.
The UCEIS score, reported in a
UCEIS assesses three areas, assigning each a score range. The areas of assessment include:
- Vascular pattern, which receives a score between 0 and 2.
- Bleeding, which receives a score between 0 and 3.
- Erosions and ulcers, which receive a score between 0 and 3.
These three UCEIS areas then combine to produce a total score. The UCEIS total score ranges from 0–8 as follows:
- 0–1 = remission
- 2–4 = mild disease activity
- 5–6 = moderate disease activity
- 7–8 = severe disease activity
Higher scores indicate more severe disease activity.
A more recent study from 2023 found similar results. Here, researchers found that the UCEIS score provides a more accurate assessment of short and long-term outcomes compared to both the MES score and the degree of ulcerative colitis burden of luminal inflammation (DUBLIN) score — another tool to help assess UC improvement.
Researchers may use participant’s self-assessments to help determine the accuracy of the screening score. Some evidence suggests that self-reported outcomes may be just as accurate as other scoring metrics.
However, more research may be necessary to fully assess accuracy across the various metrics, including reported outcomes.
Most UC treatment plans strive for significant disease improvement or, ideally, remission. Remission means that the disease shows no signs or symptoms of activity.
To achieve endoscopic improvement, a person will likely need to work with one or more healthcare professionals to develop a treatment plan that works for them. This may include medications alongside lifestyle changes to help improve the condition.
The American College of Gastroenterology (ACG) clinical guidelines suggest doctors should vary UC medications based on factors such as:
- response to previous medications
- severity of UC
- necessity of treatment to induce or maintain remission
Common medications include:
- mesalamine or other types of 5-aminosalicylates
A person may also find making lifestyle changes can help them achieve endoscopic improvement. Some tips include:
- quitting smoking if necessary, under medical guidance
- avoiding fatty or high fiber foods
- exercising regularly
- managing stress
- taking medications as prescribed
- having regular checkups
- recording flares and reporting them to the healthcare team
Endoscopic improvement in UC means a person’s symptoms and disease severity have decreased with treatment.
Doctors and researchers can use different scoring systems to provide a relatively accurate and easy assessment of improvement. A person’s self-assessment can also play a role in determining endoscopic improvement.
To achieve endoscopic improvement, people should take all medications as prescribed, attend regular checkups with their healthcare team, and consider making lifestyle changes to manage their condition.