Moskowitz et al graded inflammation seen in biopsies from ileoanal ileal reservoirs following proctocolectomy. The type and severity of inflammation can be monitored over time and can help to gauge the effectiveness of any interventions. The author are from St. Mark's Hospital in London.
Grading Acute Inflammation
|
Histologic Parameter |
Finding |
Points |
|
polymorph infiltration |
none |
0 |
|
|
mild |
1 |
|
|
moderate with crypt abscesses |
2 |
|
|
severe with crypt abscesses |
3 |
|
ulceration per low power field |
none |
0 |
|
|
1 - 24% |
1 |
|
|
25 - 50% |
2 |
|
|
51 - 100% |
3 |
where:
• The score is similar to the histologic component of the Pouchitis Disease Activity Index.
Grading Chronic Inflammation
|
Histologic Parameter |
Finding |
Points |
|
chronic inflammation |
absent |
0 |
|
|
mild and patchy |
1 |
|
|
moderate |
2 |
|
|
severe |
3 |
|
villous atrophy |
absent |
0 |
|
|
partial |
1 |
|
|
subtotal |
2 |
|
|
total |
3 |
histological grade for acute inflammation =
= (points for polymorph infiltration) + (points for ulceration)
histological grade for chronic inflammation =
= (points for chronic inflammation) + (points for villous atrophy)
Interpretation:
• minimum acute or chronic inflammation: 0
• maximum acute or chronic inflammation: 6
• Inflammation was severe if the grade was >= 4.
Clinical pouchitis was associated with:
(1) macroscopic inflammation on endoscopic examination
(2) diarrhea
(3) acute inflammation with histologic grade >= 4 (severe)
Specialty: Gastroenterology
