Assessment of disease activity in ulcerative colitis

Management of ulcerative colitis (UC) is guided by the anatomical distribution of disease, severity of symptoms, response to medical therapy and ability of the patient to tolerate treatment. In its most severe form, acute ulcerative colitis can carry major morbidity and can be fatal. Disease severity indices help guide clinical decisions regarding appropriate initial treatment and are particularly helpful for patients who fail to show adequate response to first-line therapy but are also essential for evaluating therapeutic response and defining outcomes in clinical trials (D’Haens et al., Gastroenterology 132:763–786, 2007). Indeed, severity indices were all developed for use in clinical trials, although almost none have been formally validated and none have had responsiveness defined in clinical practice.