Histological healing in inflammatory bowel disease: A still unfulfilled promise

Table 3 Histological scoring system for ulcerative colitis and Crohn’s disease

Ulcerative colitis
Grade 0	Structural (architectural change)
0	No abnormality
0.1	Mild abnormality
0.2	Mild or moderate diffuse or multifocal abnormalities
0.3	Severe diffuse or multifocal abnormalities
Grade 1	Chronic inflammatory infiltrate
1	No increase
1.1	Mild but unequivocal increase
1.2	Moderate increase
1.3	Marked increase
Grade 2	Lamina propria neutrophils and eosinophils
2A. Eosinophils
2A.0	No increase
2A.1	Mild but unequivocal increase
2A.2	Moderate increase
2A.3	Marked increase
2B. Neutrophils
2B.0	None
2B.1	Mild but unequivocal increase
2B.2	Moderate increase
2B.3	Marked increase
Grade 3	Neutrophils in epithelium
3	None
3.1	< 5% crypt involved
3.2	< 50% crypt involved
3.3	> 50% crypt involved
Grade 4	Crypt destruction
4	None
4.1	Probable-local excess of neutrophils in part of crypt
4.2	Probable-marked attenuation
4.3	Unequivocal crypt destruction
Grade 5	Erosion or ulceration
5	No erosion, ulceration, or granulation tissue
5.1	Recovering epithelium plus adjacent inflammation
5.2	Probable erosion-focally stripped
5.3	Unequivocal erosion
5.4	Ulcer or granulation tissue
Crohn’s disease
Epithelial damage
0	Normal
1	Focal pathology
2	Extensive pathology
Architectural changes
0	Normal
1	Moderately disturbed (< 50%)
2	Severely disturbed (> 50%)
Infiltration of mononuclear cells in the lamina propria
0	Normal
1	Moderate increase
2	Severe increase
Infiltration of polymorphonuclear cells in the lamina propria
0	Normal
1	Moderate increase
2	Severe increase
Polymorphonuclear cells in the epithelium
1	In surface epithelium
2	Cryptitis
3	Crypt abscess
Presence of erosions and/or ulcers
0	No
1	Yes
Presence of granuloma
0	No
1	Yes
No. of biopsy specimens affected
0	None (0 of 6)
1	< 33% (1 or 2 of 6)
2	33%-66% (3 or 4 of 6)
3	> 66% (5 or 6 of 6)

Each topic scored independently. Moderate increase, up to twice the number of cells that can normally be expected; severe increase, more than twice the normal number of cells.