What is endoscopic improvement in ulcerative colitis?

Measuring certain areas involved in ulcerative colitis (UC) over time can help monitor for signs of improved disease, known as endoscopic improvement.
Doctors, researchers, and other healthcare professionals use different forms of measurement to determine if a person with UC is showing signs of improvement. One such measure is endoscopic improvement.
This article reviews what endoscopic improvement means, how doctors measure it, and how a person can achieve it.
Defining endoscopic improvement
Endoscopic improvement means a person with UC is showing improved signs of disease activity or severity during an endoscopic evaluation, such as a colonoscopy or sigmoidoscopy.
means
It involves measurements or scoring performed by a person’s doctor or healthcare team immediately following an endoscopic evaluation. These measurements are then tracked over time to determine if the disease is improving or worsening.
How is endoscopic improvement measured? 
There are a few ways to measure endoscopic improvement:
The most commonly used score — in both practice and clinical studies — is the Mayo Endoscopic Score (MES). The reason for its wide adoption and acceptance includes its ease of use, simplicity, and practicality as well as its mostly repeatable results.
most commonly used score
The MES measures mucosal inflammation found during an endoscopy on the following scale:
scale
0 = normal
1 = erythema, decreased vascular pattern, and mild friability
2 = marked erythema, absent vascular pattern, friability, and erosions
3 = ulceration and spontaneous bleeding
The lower the MES score, the better.
A lower MES score is associated with several aspects of improved health, including reduced risk for:
associated
hospitalization
relapse
need for a colectomy, which is a surgical procedure
cancer
dysplasia
However, researchers note limitations in the MES scoring system. They suggest it may not be the most effective tool for measuring endoscopic response. Due to its simplicity, it may over or underestimate endoscopic improvement, leading to an incorrect clinical assessment.
limitations
While the researchers also note that this scoring system is easy to use and produces mostly repeatable results, they suggest other tools may better show incremental healing that the current forms of measurement do not accurately show. Other tools, such as the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) score, are more accurate and may show better incremental healing.
The UCEIS score, reported in a 2012 study, provides a potentially more accurate assessment of endoscopic improvement.
2012 study
UCEIS assesses three areas, assigning each a score range. The areas of assessment include:
Vascular pattern, which receives a score between 0 and 2.
Bleeding, which receives a score between 0 and 3.
Erosions and ulcers, which receive a score between 0 and 3.
These three UCEIS areas then combine to produce a total score. The UCEIS total score ranges from 0–8 as follows:
0–1 = remission
2–4 = mild disease activity
5–6 = moderate disease activity
7–8 = severe disease activity
Higher scores indicate more severe disease activity.
A 2016 study found that the UCEIS provides a more accurate assessment of endoscopic improvement for people with UC compared to the MES score. They suggest it gives a more accurate view of both short- and long-term outcomes of the disease.
2016 study
A more recent study from 2023 found similar results. Here, researchers found that the UCEIS score provides a more accurate assessment of short and long-term outcomes compared to both the MES score and the degree of ulcerative colitis burden of luminal inflammation (DUBLIN) score — another tool to help assess UC improvement.
study from 2023
Researchers may use participant’s self-assessments to help determine the accuracy of the screening score. Some evidence suggests that self-reported outcomes may be just as accurate as other scoring metrics.
evidence suggests
However, more research may be necessary to fully assess accuracy across the various metrics, including reported outcomes.
How to achieve endoscopic improvement 
Most UC treatment plans strive for significant disease improvement or, ideally, remission. Remission means that the disease shows no signs or symptoms of activity.
To achieve endoscopic improvement, a person will likely need to work with one or more healthcare professionals to develop a treatment plan that works for them. This may include medications alongside lifestyle changes to help improve the condition.
The American College of Gastroenterology (ACG) clinical guidelines suggest doctors should vary UC medications based on factors such as:
American College of Gastroenterology (ACG) clinical guidelines
response to previous medications
severity of UC
necessity of treatment to induce or maintain remission
Common medications include:
mesalamine or other types of 5-aminosalicylates
immunomodulators
biologics
corticosteroids
A person may also find making lifestyle changes can help them achieve endoscopic improvement. Some tips include:
quitting smoking if necessary, under medical guidance
avoiding fatty or high fiber foods
exercising regularly
managing stress
taking medications as prescribed
having regular checkups
recording flares and reporting them to the healthcare team
Summary
Endoscopic improvement in UC means a person’s symptoms and disease severity have decreased with treatment.
Doctors and researchers can use different scoring systems to provide a relatively accurate and easy assessment of improvement. A person’s self-assessment can also play a role in determining endoscopic improvement.
To achieve endoscopic improvement, people should take all medications as prescribed, attend regular checkups with their healthcare team, and consider making lifestyle changes to manage their condition.