Real-world use of endoscopic and histological indices in ulcerative colitis: Results of a global survey

Background: Treatment targets of ulcerative colitis (UC) have evolved to include not only endoscopic but also histologic remission. However, the concept of histological activity is still in its early days. We aimed to capture the attitudes toward UC histology and the uptake of standardized reporting of endoscopy and histology of UC in daily practice. Methods: We conducted a cross-sectional survey of physicians involved in the care of inflammatory bowel disease worldwide. The survey included 21 questions divided into three sections. The first recorded demographics, specialty, and level of experience of participants; the second covered clinical practices and attitudes toward the use and reporting of endoscopy; and the third covered histology. Results: In total, 359 participants from 60 countries and all levels of experience completed the survey. UC histology was used by nearly all respondents (90.5%) for initial diagnosis, by 72% to monitor disease course, by 62.4% to determine the microscopic extension, by 59.9% to confirm deep remission when considering to stop treatment, and 42.3% to increase/optimize treatment. Nevertheless 77.2% of participants reported that no standard histological index was available in their daily practice. Instead, endoscopy reports included the Mayo Endoscopic score in 90% of cases. The majority of respondents welcomed as useful or very useful an artificial intelligence system to automate scoring of endoscopy (69%) or histology (73%). Conclusion: UC histology reports are less standard than endoscopy reports, although most physicians consider histological activity useful when managing UC and would welcome artificial intelligence systems to automate endoscopic and histological scoring.