The IBD-DCA score in the pathological assessment of ulcerative colitis and Crohn’s disease: observations from a single-center experience

Abstract Background Inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), are chronic disorders that require histopathological evaluation for diagnosis and disease monitoring. Despite its clinical importance, histological reporting lacks standardization. The IBD-DCA score was recently proposed as a simple and reproducible tool applicable to both UC and CD. However, its practical utility in routine pathology settings has not been fully explored. Methods In this cross-sectional observational study, 149 endoscopic biopsy samples from patients with suspected or confirmed IBD were evaluated between July 2023 and July 2024. Histological analysis was performed using the IBD-DCA score, which includes Distribution (D), Chronicity (C), and Activity (A) parameters. Scores were correlated with colonoscopic findings, clinical stage (initial diagnosis vs. follow-up), and biopsy fragment count. Statistical analyses included chi-square, t-tests, Mann–Whitney U, and ANOVA, with p < 0.05 considered significant. Results Among the samples, 94 (63.1%) were from UC and 55 (36.9%) from CD patients. UC samples more frequently showed D2 grading (83.0% vs. 56.4%), while CD samples had higher D0 and D1 grades (both 21.8%) ( p < 0.001). Chronicity also differed: C1 was more frequent in CD (45.5%), whereas UC presented higher rates of C0 (43.6%) and C2 (40.4%) ( p < 0.001). No significant difference in A grading was observed between groups. When compared to newly diagnosed patients, those under follow-up showed fewer A2 grades (36.3% vs. 41.4%; p = 0.004) and more C1/C2 grades ( p = 0.005). Segments with abnormal endoscopic findings showed significantly more D2 (80.8%), C2 (45.5%), and A2 (53.5%) grades compared to macroscopically normal segments (D2: 50.0%; C2: 15.0%; A2: 10.0%) ( p < 0.001). A higher number of biopsy fragments was associated with higher A and C scores ( p < 0.001), but not with distribution. Conclusions The IBD-DCA score demonstrated strong correlation with clinical and endoscopic features and proved to be a feasible and informative tool for pathological assessment in IBD. Its use may enhance report standardization and multidisciplinary communication. Multicenter validation is encouraged.