Inflammatory Bowel Diseases: Does One Histological Score Fit All?

Abstract

Mucosal healing (MH) is the main treatment target in ulcerative colitis (UC) and Crohn’s disease, and it is defined by the combination of complete endoscopic and histologic remission. The complete resolution of mucosal inflammation should be confirmed by histology but its assessment is not always univocal. Neutrophil infiltration represents the unique histological marker in discriminating the active vs. quiescent phases of the disease, together with crypt injuries (cryptitis and crypt abscesses), erosions, and ulcerations. On the contrary, basal plasmacytosis is not indicative of activity or the remission of inflammatory bowel diseases (IBDs) but instead represents a diagnostic clue, mostly at the onset. Several histological scoring systems have been developed to assess grade severity, particularly for UC. However, most are complex and/or subjective. The aim of this review was to summarize available scores, their characteristics and limitations, and to present the advantages of a simplified mucosa healing scheme (SHMHS) based on neutrophils and their distribution in the gut mucosa. Finally, we overview future developments including artificial intelligence models for standardization of disease assessments and novel molecular markers of inflammation with potential application in diagnostic practice.

Mechanism of Action of Melatonin as a Potential Adjuvant Therapy in Inflammatory Bowel Disease and Colorectal Cancer

“…There are no conclusive results concerning the role of neutrophils in IBD, yet some studies found that colitis could be reduced with anti-neutrophil antibodies, while other studies showed that colitis is aggravated after depleting the number of neutrophils by using antiserum or by inhibiting their adhesions with anti-L-selectin mAB [ 150 ]. However, studies on humans showed that the increase in neutrophils is one of the histological parameters of IBD pathogenesis [ 151 ].…”