Histopathological assessment of the intensity and activity of the inflammation in inflammatory bowel diseases: An important addition to the endoscopy, or a pointless effort?

Expanding amount of knowledge about inflammatory bowel diseases has changed current therapeutic goals. In the past times, the main effort of the gastroenterologists was to alleviate patients symptoms. But nowadays, one of the hot topics is a mucosal healing and achieving the endoscopic, eventually even microscopic remission. Therefore, the objective assessment of the microscopic intensity and activity of the inflammation starts to assume its importance and histopathological scoring systems can represent an useful tool. However, their actual contribution is ill-defined. The aim of this review is to inform about available histopathological scoring systems for ulcerative colitis (UC) and Crohns disease (CD) and discuss their benefits and limitations. A systematic literature search in databases OVID SP MEDLINE, OVID EMBASE a The Cochrane library found 19 scoring indexes for UC and 4 for CD were found. The vast majority of them are not validated and their benefit for prediction of the clinical outcome is controversial. Endoscopy still represents a gold standard in the assessment of the extent of the bowel inflammation.