Measuring histologic activity in inflammatory bowel disease: Why and how

Reetesh K. Pai, Gregory Y. Lauwers, Rish K. Pai

Research output: Contribution to journalReview articlepeer-review


Histology is used to confirm the diagnosis of inflammatory bowel disease, exclude superimposed infections, and to evaluate for dysplasia. Histology has rarely been used to measure disease activity and guide therapy despite evidence that histologic measurements have value in predicting important clinical outcomes. More recently, there have been numerous studies supporting a role for histologic disease activity measurements in predicting a variety of outcomes including relapse, hospitalizations, steroid use, and dysplasia. The histologic assessment was superior to endoscopic measurements in many of these studies. This review will summarize the recent literature regarding histologic disease activity measurements in ulcerative colitis and Crohn disease. A detailed description of histologic scoring systems will also be provided to provide pathologists with the necessary tools to accurately measure disease activity.

Original languageEnglish (US)
Pages (from-to)37-47
Number of pages11
JournalAdvances in anatomic pathology
Issue number1
StatePublished - Jan 1 2022


  • Crohn disease
  • Geboes Score
  • Histologic healing
  • Inflammatory bowel disease
  • Mucosal healing
  • Nancy index
  • Robarts histopathology index
  • Ulcerative colitis

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine


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