Growing interest in histological measurements of inflammatory activity to determine therapeutic efficacy and endpoints in IBD has been accompanied by progress in developing and validating scoring instruments for this purpose.1–5 Four histological grading instruments, the Geboes score, Nancy index, Robarts Histological Index (RHI) and modified Riley score, have recently demonstrated responsiveness to clinical changes based on data from a phase II trial of ozanimod.6 Further refinement of the operating characteristics of these instruments and definition of threshold values for remission can be expected.7 Less attention has been given to pre-analytical factors which might affect the histological assessment of disease activity and the definition of therapeutic endpoints, such as biopsy sampling density and target selection. Clinical consensus guidelines have thus far provided only empirical guidance. The European Crohn’s and Colitis Organisation (ECCO) guidelines for initial IBD diagnosis recommend two forceps biopsies from each of five sites in the colorectum and terminal ileum and separate biopsies from endoscopically distinct regions8 but do not address sampling density and target selection in other clinical situations. Likewise, uniform standards for biopsy sampling in therapeutic drug trials are lacking. One study has reported good endoscopic concordance between the rectosigmoid and proximal colon at baseline …

中文翻译：

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溃疡性结肠炎的微观异质性：对疾病活动的微观测量的影响

迄今为止，临床共识指南仅提供了经验指导。欧洲克罗恩病和结肠炎组织 (ECCO) 的初始 IBD 诊断指南建议从结肠直肠和末端回肠的五个部位中的每一个部位进行两次活检，并从内窥镜不同的区域进行活检 8，但没有解决其他临床情况下的采样密度和目标选择。同样，缺乏治疗药物试验中活检取样的统一标准。一项研究报告了基线时直肠乙状结肠和近端结肠之间良好的内窥镜一致性…… 欧洲克罗恩病和结肠炎组织 (ECCO) 的初始 IBD 诊断指南建议从结肠直肠和末端回肠的五个部位中的每一个部位进行两次活检，并从内窥镜不同的区域进行活检 8，但没有解决其他临床情况下的采样密度和目标选择。同样，缺乏治疗药物试验中活检取样的统一标准。一项研究报告了基线时直肠乙状结肠和近端结肠之间良好的内窥镜一致性…… 欧洲克罗恩病和结肠炎组织 (ECCO) 的初始 IBD 诊断指南建议从结肠直肠和末端回肠的五个部位中的每一个部位进行两次活检，并从内窥镜不同的区域进行活检 8，但没有解决其他临床情况下的采样密度和目标选择。同样，缺乏治疗药物试验中活检取样的统一标准。一项研究报告了基线时直肠乙状结肠和近端结肠之间良好的内窥镜一致性……