Rachmilewitz et al reported a clinical activity and endoscopic indices for evaluating a patient with ulcerative colitis. This can be used to monitor a patient over time and to evaluate the response to therapy. The authors are from Hadassah University Hospital in Jerusalem and from multiple institutions from Europe and South Africa.
Parameters for the clinical activity index:
(1) number of stools passed per week
(2) average amount of blood in stool over a week
(3) global assessment by the investigator of the patient's symptomatic state
(4) abdominal cramping and/or pain
(5) fever associated with colitis in °C
(6) extraintestinal manifestations
(7) laboratory findings (ESR and hemoglobin)
Parameters for the endoscopic index:
(1) granulation tissue that scatters reflected light
(2) appearance of the vascular pattern
(3) mucosal vulnerability
(4) damage to the mucosa (erosions, ulcerations, exudates, etc)
|
Clinical Activity Parameter |
Finding |
Points |
|
number of stools per week |
1 to 18 |
0 |
|
|
18 to 35 |
1 |
|
|
36 to 60 |
2 |
|
|
> 60 |
3 |
|
average blood in stool |
none |
0 |
|
|
a little |
2 |
|
|
a lot |
4 |
|
global assessment |
good |
0 |
|
|
average |
1 |
|
|
poor |
2 |
|
|
very poor |
3 |
|
abdominal cramps and/or pain |
none |
0 |
|
|
mild |
1 |
|
|
moderate |
2 |
|
|
severe |
3 |
|
fever (temperature > 38°C) |
absent |
0 |
|
|
present |
3 |
|
iritis |
absent |
0 |
|
|
present |
3 |
|
erythema nodosa |
absent |
0 |
|
|
present |
3 |
|
arthritis |
absent |
0 |
|
|
present |
3 |
|
laboratory findings |
ESR <= 50 mm in 1st hour and hemoglobin >= 10 g/dL |
0 |
|
|
ESR 50 to 100 mm in 1st hour |
1 |
|
|
ESR > 100 mm in 1st hour |
2 |
|
|
hemoglobin < 10 g/dL |
4 |
|
Endoscopic Parameter |
Finding |
Points |
|
granulation scattering of light |
no |
0 |
|
|
yes |
2 |
|
vascular pattern |
normal |
0 |
|
|
disturbed or faded |
1 |
|
|
completely absent |
2 |
|
mucosal vulnerability |
none |
0 |
|
|
slightly increased (contact bleeding) |
2 |
|
|
marked increased (spontaneous bleeding) |
4 |
|
mucosal damage |
none |
0 |
|
|
slight |
2 |
|
|
pronounced |
4 |
clinical activity index =
= SUM(points for all 7 parameters)
endoscopic index =
= SUM(points for all 4 parameters)
Interpretation:
• minimum indices: 0
• maximum clinical activity index: 29
• maximum endoscopic index: 12
Specialty: Gastroenterology
