supplementarytable,1:,simple,clinical,colitis,activity,index ......supplementary information in...

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Supplementary Table 1: Simple Clinical Colitis Activity Index (SCCAI) Descriptor Description Score

Bowel frequency (day)

0-‐3 4-‐6 7-‐9 >9

0 1 2 3

Bowel frequency (night)

0 1-‐3 4-‐6

0 1 2

Urgency of defecation

None Hurry Immediately (toilet nearby) Incontinence

0 1 2 3

Blood in stool None Trace Occasionally frank (<50% of defecation) Usually frank (>50% of defecation)

0 1 2 3

General well being very well slightly below par poor very poor terrible

0 1 2 3 4

Extracolonic features

1 per manisfestation Arthritis Yes No Uveitis Yes No Erythema nodosum Yes No Pyoderma gangenosum Yes No

1 0 1 0 1 0 1 0

Total (out of 19)

Reproduced from: A simple clinical colitis activity index, Walmsley RS, Ayres RCS, Pounder RE, Allan RN, 43, 29–32, 1998 with permission from BMJ Publishing Group Ltd.



Supplementary Table 2: Partial Mayo Score Descriptor Description Score

Stool frequency* Normal stools 1-‐2 stools more than normal 3-‐4 stools more than normal ≥5 stools more than normal

0 1 2 3

Rectal bleeding No blood seen Streaks of blood with stool less than half the time Obvious v=blood with stool most of the time Obvious blood alone passed

0 1 2 3

Physician Global assessment Normal Mild disease Moderate disease Severe disease

0 1 2 3

Total (out of 9)

* Each patient served as his or her own control to establish the degree of abnormality of the stool frequency.

Schroeder KW, Tremaine WJ, Ilstrup DM. Coated oral 5-‐aminosalicylic acid therapy for mildly

to moderately active ulcerative colitis. N Engl J Med 1987;317:1625-‐1629.

Sandborn WJ, Sands BE, Wolf DC, et al. Repifermin (keratinocyte growth factor-‐2) for

treatment of active ulcerative colitis: a randomized double-‐blind, placebo-‐controlled, dose-‐

escalation trial. Aliment Pharmacol Ther 2003;17:1355-‐1364.



Supplementary Table 3: Pediatric Ulcerative Colitis Activity Index (PUCAI) Descriptor Description Score Abdominal pain No pain

Pain can be ignored Pain cannot be ignored

0 5 10

Rectal bleeding None Small amount only in <50% of stools Small amount with most stools Large amount (>50% of the stool content)

0 10 20 30

Stool consistency of most stools

Formed Partially formed Completely unformed

0 5 10

Number of stools per 24 hours

0-‐2 3-‐5 6-‐8 >8

0 5 10 15

Nocturnal stools (any episode causing wakening)

No Yes

0 10

Activity level No limitation of activity Occasional limitation of activity Severe restricted activity

0 5 10

Total of PUCAI (0-‐85)

Turner D, Otley AR, Mack D, et al. Development, validation, and avaluation of a pediatric ulcerative colitis activity index: A prospective multicenter study. Gastroenterology. 2007;133:423-‐432. Reproduced with permission from copyright holder.



Supplementary Table 4: Truelove and Witts’ Severity Index for use in Acute Severe Ulcerative Colitis Variable Mild Disease Severe Disease

Stools (number/day) <4 >6

Blood in stool Intermittent Frequent

Temperature (°C) normal >37.5

Pulse (beats/minute) Normal >90

Haemoglobin Normal <75% of normal

Erythrocyte

Sedimentation Rate

(mm/hr)

≤30 >30

* Moderate disease intermediate between mild and severe.

Truelove SC, Witts LT. Cortisone in ulcerative colitis: final report on a therapeutic trial. BMJ

1955;2:1041-‐1048.



Supplementary Table 5: Ulcerative Colitis Endoscopic Index of Severity (UCEIS)

Descriptor (Score most

severe lesions)

Likert Scale anchor points Definition

Vascular pattern

Normal (0) Normal vascular pattern with arborisation of capillaries clearly defined, or with blurring or patchy loss of capillary margins

Patchy obliteration (1) Patchy obliteration of vascular pattern

Obliterated (2) Complete obliteration of vascular pattern

Bleeding

None (0) No visible blood

Mucosal (1) Some spots or streaks of coagulated blood on the surface of the mucosa ahead of the scope, which can be washed away

Luminal mild (2) Some free liquid blood in the lumen Luminal moderate or severe (3)

Frank blood in the lumen ahead of endoscope or visible oozing from mucosa after washing intra-‐luminal blood, or visible oozing from a hemorrhagic mucosa

Erosions & Ulcers

None (0) Normal mucosa, no visible erosions or ulcers

Erosions (1) Tiny (<5mm) defects in the mucosa, of a white or yellow color with a flat edge

Superficial ulcer (2)

Larger (>5mm) defects in the mucosa, which are discrete fibrin-‐covered ulcers when compared to erosions, but remain superficial

Deep ulcer (3) Deeper excavated defects in the mucosa, with a slightly raised edge

* UCEIS© copyright is registered to Watson Laboratories, Parsippany NJ, United States a subsidiary of Actavis Inc., as successor in interest of Warner Chilcott and Procter & Gamble (“Licensor”), on the principle that there is unrestricted access to the UCEIS©. Travis SPL, Schnell D, Krzeski P, Abreu MT, Altman DG, Colombel JF, Feagan BG, Hanauer SB, Lichtenstein GR, Marteau PR, Reinisch W, Sands BE, Yacyshyn BR, Schnell P, Bernhardt CA, Mary JY, Sandborn WJ. Reliability and initial validation of the Ulcerative Colitis Endoscopic Index of Severity (UCEIS). Gastroenterology 2013; 145:987-‐95. Reproduced with permission from copyright holder.



Supplementary Table 6: Mayo Clinic Index: endoscopic subscore

Score Disease Activity Endoscopic features (‘descriptors’) 0 Normal or inactive None 1 Mild Erythema, decreased vascular pattern,

mild friability 2 Moderate Marked erythema, absent vascular pattern,

friability, erosions 3 Severe Spontaneous bleeding, ulceration

Schroeder KW, Tremaine WJ, Ilstrup DM. Coated oral 5-‐aminosalicylic therapy for mildly to moderately active ulcerative colitis. A randomized study. BMJ 1987;317(26):1625-‐9.



Supplementary table 7: Riley histological score

Histological feature Grade Acute inflammatory infiltrate 0 None 1 Mild 2 Moderate 3 Severe Crypt abscesses 0 None 1 Mild 2 Moderate 3 Severe Mucin depletion 0 None 1 Mild 2 Moderate 3 Severe Surface epithelial integrity 0 None 1 Mild 2 Moderate 3 Severe Chronic inflammatory infiltrate 0 None 1 Mild 2 Moderate 3 Severe Crypt architectural abnormalities 0 None 1 Mild 2 Moderate 3 Severe Riley SA, Mani V, Goodman MJ, et al. Microscopic activity in ulcerative colitis: What does it mean? Gut 1991;32:174-‐8.



Supplementary Table 8: Geboes histological score Grade Subgrade Features 0 Structural 0.0 No abnormality 0.1 Mild abnormality 0.2 Mild or moderate diffuse or multifocal abnormalities 0.3 Severe diffuse or multifocal abnormalities 1 Chronic

inflammatory infiltrate

1.0 No increase 1.1 Mild but unequivocal increase 1.2 Moderate increase 1.3 Marked increase 2 Lamina propria Eosinophils 2A.0 No increase 2A.1 Mild but unequivocal increase 2A.2 Moderate increase 2A.3 Marked increase Neutrophils 2B.0 No increase 2B.1 Mild but unequivocal increase 2B.2 Moderate increase 2B.3 Marked increase 3 Neutrophils in

epithelium

3.0 None 3.1 <5% crypts involved 3.2 <50% crypts involved 3.3 >50% crypts involved 4 Crypt destruction 4.0 None 4.1 Probable-‐local excess of neutrophils in part of crypt 4.2 Probable-‐ marked attenuation 4.2 Unequivocal crypt destruction 5 Erosion or ulceration 5.0 No erosion, ulceration, or granulation tissue 5.1 Recovering epithelium + adjacent inflammation 5.2 Probable erosion-‐ focally stripped 5.3 Unequivocal erosion 5.4 Ulcer or granulation tissue Reproduced from: A reproducible grading system for histological assessment of inflammation in ulcerative colitis, Geboes K, Riddell R, Ost A, et al, 47, 404-‐409, 2000 with permission from BMJ Publishing Group Ltd.



Supplementary Table 9: Nancy Histological Index

Reproduced from: Development and validation of the Nancy histological index for UC, Marchal-‐Bressenot A, Salleron J, Boulagnon-‐Rombi C, et al, gutjnl-‐2015-‐310187, 2015, with permission from BMJ Publishing Group Ltd.



Supplementary Table 10: Robarts Histopathology Index Component Features Score Chronic inflammatory infiltrate No increase 0

Mild but unequivocal increase

1

Moderate increase 2 Marked increase 3

Lamina propria neutrophils No increase 0 Mild but unequivocal increase

1

Moderate increase 2 Marked increase 3

Neutrophils in epithelium None 0 <5% crypts involved 1 <50% crypts involved 2 >50% crypts involved 3

Erosion or ulceration No erosion, ulceration or granulation tissue

0

Recovering epithelium + adjacent inflammation, OR Probable erosion-‐ focally stripped

1

Unequivocal erosion 2 Ulcer or granulation tissue 3

Mosli MH, Feagan BG, Zou G, et al. Development and validation of a histological index for UC. Gut. 2015 Oct 16. pii: gutjnl-‐2015-‐310393. doi: 10.1136/gutjnl-‐2015-‐310393. [Epub ahead of print] Reproduced from: Development and validation of a histological index for UC, Mosli MH, Feagan BG, Zou G, et al, gutjnl-‐2015-‐310393, 2015, with permission from BMJ Publishing Group Ltd.



Supplementary table 11: Magnetic resonance colonography simplified index (MRC-‐S) MRC feature Criteria Score Relative contrast enhancement (RCE)

RCE >100% 1

Edema Yes 1 Enlarged lymph nodes Yes 1 Comb sign Yes 1 Ordas I, Rimola J, Garcia-‐Bosch O, et al. Diagnostic accuracy of magnetic resonance colonography for the evaluation of disease activity and severity in ulcerative colitis: a prospective study. Gut 2013;62:1566-‐1572.



Supplementary table 12: Segmental magnetic resonance score (MR-‐score-‐S) MRI Feature Description Score Diffusion weighted imaging hyperintensity (DWI-‐HI)

Presence of hyperintensity in the colonic wall segment in the DWI sequence

1

Rapid gadolinium enhancement after intravenous contrast medium administration

Gadolinium enhancement in the arterial phase (20-‐25 seconds after infusion)

1

Differentiation between mucosa-‐submucosa complex and muscularis mucosa

Distinction in the colonic wall between 2 layers: 1) mcuosa-‐submusosa complex hyperintensity; 2) muscularis propria hypointensity

1

Bowel wall thickening Thickness of the colonic wall exceeding 5mm

1

Parietal oedema Thickness of the colonic wall exceeding 5mm and hyperintensity of the mucosa-‐submucosa complex

1

Ulceration Loss of substance in the mucosa-‐submucosa complex

1

Adapted by permission from BMJ Publishing Group Limited. Diffusion-‐weighted magnetic resonance without bowel preparation for detecting colonic inflammation in inflammatory bowel disease, Oussalah A, Laurent V, Bruot V, et al., Gut, 59, 1056-‐65, 2010.



Supplementary table 13: Bowel ultrasound severity score Grade Features* 0 Colonic wall thickness <4mm and no or scarce intramural blood flow 1 Colonic wall thickness 4-‐6mm and blood flow 2 Colonic wall thickness 6-‐8mm and blood flow 3 Colonic wall thickness >8mm and blood flow *Maximal thickness of the colonic wall (obtained by three measures of the most thickened involved tract wall), measured, in transverse section, from the hyperechoic margin of the wall (representing the serosa) Parente F, Molteni M, Marino B, et al. Are colonoscopy and bowel ultrasound useful for assessing response to short-‐term therapy and predicting disease outcomes of moderate to severe forms of ulcerative colitis?: A prospective study. Am J Gastroenterol 2010;105:1150-‐1157.



Supplementary Table 14: Oxford Criteria in acute severe colitis On day 3 of intravenous corticosteroids for a hospitalized patient with acute severe ulcerative colitis:

-‐ Stool frequency >8 per day -‐ Stool frequency 3-‐8 per day AND CRP>45mg/L

Predictive of colectomy in 85% of patients during hospital admission, and warrants salvage therapy (either medical or surgical) Travis S.P et al. Predicting outcomes in severe ulcerative colitis. Gut 38, 905-‐10 (1996).



Supplementary Table 15: IBD-‐Control

Reproduced from Gut, Bodger, K. et al, 63, 1092-‐1102, 2014 with permission from BMJ Publishing Group Ltd.

Note: The IBD-‐Control-‐8 is taken from the following questions:1a,1b, and 3a to 3f Each question is scored as follows:

0 -‐ 'worst' response (that's either a 'Yes' or 'No' depending on the question -‐ should be obvious which). 1 -‐ intermediate/indeterminate (='Not Sure') 2 -‐ best response (that's either a 'Yes' or 'No' depending on the question -‐ should be obvious which)



1a Yes=2, No=0, unsure=1, 1b Yes=0, No=2, unsure = 1, taking no therapy =1. 3a to 3f Yes = 0, No=2, unsure=1 So, if all the responses are favourable then 8 X 2 = 16 (best control). If all responses are unfavourable, score 0 (worst control). If patient not on medication, then they will need to tick a box for item 1b and that gets a score of 1 on that item. Adding the transition question (item 2) may be useful and has been recommended-‐ it's not part of score but a stand alone indicator of direction of control over last 2 weeks.



Supplementary Table 16: Short quality of life in inflammatory bowel disease questionnaire (SIBDQ)

This questionnaire is designed to find out how you have been feeling during the last 2 weeks. You will be asked about symptoms you have been having as a result of your inflammatory bowel disease the way you have been feeling in general, and how your mood has been.

1. How often has the feeling of fatigue or of being tired and worn out been a problem for you during the last 2 weeks? Please indicate how often the feeling of fatigue or tiredness has been a problem for you during the last 2 weeks by picking one options from

1. All of the time 2. Most of the time 3. A good bit of the time 4. Some of the time 5. A little of the time 6. Hardly any of the time 7. None of the time

2. How often during the last 2 weeks have you had to delay or cancel a social engagement because of your bowel problem'.' Please choose an option from


3. How much difficulty have you had, as a result of your bowel problems, doing leisure or sports activities you would have liked to have done during the last 2 weeks? Please choose an option from

1. A great deal of difficulty, activities made impossible 2. A lot of difficulty 3. A fair bit of difficulty 4. Some difficulty 5. A little difficulty 6. Hardly any difficulty 7. No difficulty; the bowel problems did not limit sports or leisure activities

4. How often during the last 2 weeks have you been troubled by pain in the abdomen? Please choose an option from

1. All of the time



2. Most of the time 3. A good bit of the time 4. Some of the time 5. A little of the time 6. Hardly any of the time 7. None of the time

5. How often during the last 2 weeks have you felt depressed or discouraged? Pleases choose an option from

1. All of the time 2. Most of the time 3. A good bit of the time 4. Some of the time 5. A little of the time 6. Hardly any of tbe time 7. None of the time

6. Overall, in the last 2 weeks, how much of a problem have you had with passing large amounts of gas? Please choose an option from

1. A major problem 2. A big problem 3. A significant problem 4. Some trouble 5. A little trouble 6. Hardly any trouble 7. No trouble

7. Overall, in the last 2 weeks, how much of a problem have you had maintaining or getting to the weight you would like to be? Please choose an option from

1. A major problem 2. A big problem 3. A significant problem 4. Some trouble 5. A little trouble 6. Hardly any trouble 7. No trouble

8. How often during the last 2 weeks have you felt relaxed and free of tension? Please choose an option from

1. None of the time 2. A little of the time 3. Some of the time 4. A good bit of tbe time 5. Most of the time



6. Almost all of the time 7. All of the time

9. How much of the time during the last 2 weeks have you been troubled by a feeling of having to go to the bathroom even though your bowels were empty? Please choose an option from


10. How much of the time during the last 2 weeks have you felt angry as a result of your bowel problem? Please choose an option from

1. All of the time 2. Most of the time 3. A good bit of the time 4. Some of tbe time 5. A little of the time 6. Hardly any of the time 7. None of the time

The short inflammatory bowel disease questionnaire: a quality of life instrument for community physicians managing inflammatory bowel disease, Irvine EJ, Zhou Q, Thompson AK, Am. J. Gastroenterol. 91, 2571-‐8, 1996. Reproduced with permission from copyright holder.



Supplementary Table 17: Crohn’s and ulcerative colitis questionnaire-‐8 (CUCQ-‐8)

The following questions ask for your views about your bowel problem and how it has affected your life over the last two weeks. Please answer all the questions. If you are unsure about how to answer any question, just give the best answer you can. Do not spend too much time answering, as your first thoughts are likely to be the most accurate. If you do not wish to answer any of these questions, please leave it blank and complete the details of the question and reason(s) why it was not answered.

1. On how many days over the last two weeks have you felt tired?…………………..days 2. In the last two weeks did your bowel condition prevent you from going out socially?

a) No, not at all b) Yes, some of the time c) Yes, most of the time d) Yes, all of the time

3. On how many days over the last two weeks have you felt generally unwell? ……………. days 4. On how many days over the last two weeks have you felt pain in your abdomen? ……….. days 5. On how many nights in the last two weeks have you had to get up to use the toilet because of your bowel condition after you have gone to bed?..…………. nights 6. On how many days over the last two weeks has your abdomen felt bloated? …………………. days 7. In the last two weeks have you felt upset?

a) No, not at all b) Yes, some of the time c) Yes, most of the time d) Yes, all of the time

8. On how many days over the last two weeks have you had to rush to the toilet? …………. days

Total score out of 8 -‐ convert each question into a total out of 1. For example for Question 1: On how many days over the last 2 weeks have you felt tired? Days (eg if it was 14/14 days would be 1, if 7/14 days would be 0.5) Alrubaiy L, Cheung W, Dodds P, et al. Development of a short questionnaire to assess the quality of life in Crohn’s disease and ulcerative colitis. J Crohns Colitis 9, 66-‐76 (2015). Reproduced by permission of European Crohn’s and Colitis Organisation.



Supplementary Table 18: Crohn’s Disease Activity Index (CDAI) Descriptor Description Score Factor Subtotal

Liquid stools Daily number of liquid or soft stools over the last 7 days ��

Sum = X 2

Abdominal pain * Daily assessment over last 7 days ��

Sum = X 5

General well being ++ Daily assessment over last 7 days

Sum = X 7

Extraintestinal Arthritis/arthralgia Iritis/uveitis Skin/mouth lesions Peri-‐anal disease Other fistula Fever > 37.8 °C

None = 0 Yes = 1 None = 0 Yes = 1 None = 0 Yes = 1 None = 0 Yes = 1 None = 0 Yes = 1 None = 0 Yes = 1

Score = Score = Score = Score = Score = Score =

X 20 X 20 X 20 X 20 X 20 X 20

Anti-‐diarrhoeals None = 0 Yes = 1

Score = X 30

Abdominal mass None = 0 Questionable = 2 Definite = 5

Score = X 10

Haematocrit Males (47 – Hct) Females (42 – Hct)

Score = Score =

X6

Weight Standard kg Current kg

kg kg

100 x (1-‐current/standard)

TOTAL CDAI SCORE *Abdominal pain None = 0 Intermediate = 1 or 2 Severe = 3 ++ General well being Well = 0 Intermediate = 1,2 or 3 Terrible = 4 Best, W.R., Becktel, J.M., Singleton, J.W. & Kern, F., Jr. Development of a Crohn's disease activity index. National Cooperative Crohn's Disease Study. Gastroenterology 70, 439-‐44 (1976). Reproduced with permission from copyright holder.



Supplementary Table 19: Harvey Bradshaw Simple Index Descriptor Description Score General well-‐being very well

slightly below par poor very poor terrible

0 1 2 3 4

Abdominal pain none mild moderate severe

0 1 2 3

Number of liquid stools daily 1 per occurrence __ Abdominal mass none

dubious definite definite and tender

0 1 2 3

Complications 1 per item ! Arthralgia ! Uveitis ! Erythema Nodosum ! Apthous ulcer ! Pyoderma

gangrenosum ! Anal fissure ! New fistula ! Abscess

__

Total score Harvey RF, Bradshaw JM. A simple index of Crohn’s disease activity. Lancet 1980;1:514



Supplementary Table 20: Perianal Disease in Crohn’s disease Activity Index (PDAI) Descriptor Description Score Discharge No discharge

Minimal discharge Moderate mucous or purulent discharge Gross faecal soiling

0 1 2 3

Pain/restriction of activities No activity restriction Mild discomfort, no restriction Moderate discomfort, some limitations of activity Marked discomfort, marked limitations Severe pain, severe limitations

0 1 2 3 4

Restriction of sexual activity No restriction of sexual activity Slight restriction of sexual activity Moderate limitations of sexual activities Marked limitations of sexual activities Unable to engage in sexual activities

0 1 2 3 4

Type of perianal disease No perianal disease/skin tags Anal fissure/mucosal tear < 3 perianal fistulae ≥ 3 perianal fistulae Anal sphincter ulcerations or fistulae with significant undermining of skin

0 1 2 3 4

Degree of induration No induration Minimal induration Moderate induration Substantial induration Gross fluctuance/abscess

0 1 2 3 4

Total out of 19 Irvine EJ. Usual therapy improves perianal Crohn’s disease as measured by a new disease activity index. MacMaster IBD Study Group. J Clin Gastroenterol 1995;20:27-‐32. Reproduced with permission from copyright holder.



Supplementary Table 21. Example of the CDEIS scoring form

TABLE 5: Example of CDEIS scoring form

Observation Rectum Sigmoid & left colon

Transverse colon

Right colon Ileum Total

Deep ulcerations (12 if present, 0 if absent) 0 12 0 12 N/A 24 Total 1 Superficial ulceration (6 if present, 0 if absent) 6 6 6 6 N/A 24 Total 2 Surface involved by the disease (/10cm)* 5.6 4.9 3.4 5.6 N/A 19.5 Total 3

Ulcerated surface (/10cm)* 0.7 0.5 0.9 0.4 N/A 22 Total 4

Total 1 + Total 2 + Total 3 +Total 4 = 89.5 Total A

Number (n) of segments totally or partially examined (1-‐5) 4 n

Total A divided by n 22.4 Total B

Quote 3 if ulcerated stenoisis anywhere, 0 if not 3 C

Quote 3 if non ulcerated stenosis anywhere, 0 if not 0 D

Total B + C + D = 25.4 CDEIS score *analogue scales to be converted to numeric values.

The total score is divided by the number of locations explored (1–5). An additional 3 points

are given if an ulcerated stenosis is present, and a further 3 points if a non-‐ulcerated

stenosis is present. CDEIS scores range from 0 to 44.

• Deep ulcerations: score 0 if absent or 12 if present

• Superficial ulcerations: score 0 if absent or 6 if present

• Length of ulcerated mucosa (0-‐10cm): score 0-‐10 according to length in cm

• Length of diseased mucosa (0-‐10cm): score 0-‐10 according to length in cm

Reproduced from: Development and validation of an endoscopic index of the severity for Crohn's disease: a prospective multicentre study, Mary JY, Modigliani R, 30, 983-‐9, 1989 with permission from BMJ Publishing Group Ltd.



Supplementary Table 22: Simple Endoscopic Score for Crohn’s disease (SES-‐CD)

Variable 0 1 2 3

Size of ulcers

(cm)

None Aphthous ulcers

(diameter 0.1-‐

0.5 cm)

Large ulcers

(diameter 0.5-‐2

cm)

Very large

ulcers (diameter

>2 cm)

Ulcerated

surface (%)

none <10% 10-‐30% >30%

Affected surface

(%)

Unaffected

segment

<50% 50-‐75% >75%

Presence of

narrowings

none Single, can be

passed

Multiple, can be

passed

Cannot be

passed

*Total SES-‐CD: sum of the values of the 4 variables for the 5 bowel segments. Values are given to each variable and for every examined bowel segment. Daperno M, D'Haens G, Van Assche G, et al. Development and validation of a new, simplified endoscopic activity score for Crohn's disease: the SES-‐CD. Gastrointest Endosc. 2004;60(4):505-‐12. Reproduced with permission from copyright holder.



Supplementary Table 23: Rutgeerts’ Post-‐operative Endoscopic Index*

Distal ileum

Grade 0 (i0) nil

Grade 1 (i1) ≤5 aphthous ulcers

Grade 2 (i2) >5 aphthous ulcers with normal intervening mucosa, or skip areas of larger lesions or

lesions confined to the ileocolic anastomosis (ie, <1cm in length)

Grade 3 (i3) Diffuse aphthous ulceration with diffusely inflamed mucosa

Grade 4 (i4) Diffuse inflammation with large ulcers, nodules and/or narrowing

*An endoscopic scoring system for postoperative disease recurrence in Crohn’s disease.

Rutgeerts P, Geboes K, Vantrappen G, Beyls J, Kerremans R, Hiele M. Predictability of the postoperative course of Crohn's disease. Gastroenterology. 1990;99(4):956-‐63.



Supplementary table 24: Global histologic disease activity score (GHAS) in Crohn’s disease Histological feature Grade 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 lamina propria

0 Normal 1 Moderate increase 2 Severe increase

Polymorphonuclear cells in 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) 2 33%-‐66% (3 or 4 of 6) 3 >66% (5 or 6 of 6)

D’Haens G, Geboes K, Peeters M, et al. Early lesions of recurrent Crohn’s disease caused by infusion of intestinal content in excluded ileum. Gastroenterology 1998;114:262-‐267. Reproduced with permission from copyright holder.



Supplementary Table 25: Magnetic Resonance Index of Activity (MaRIA) MaRIA is based on Magnetic resonance enterography (MRE), which requires oral contrast for luminal distension. In addition, colon distension may be performed with use of a neutral contrast enema (eg. Water). The MaRIA is calculated using the following parameters on MRE: MRE Feature Description Bowel wall thickness Measured in millimetres Relative contrast enhancement Enhancement of the bowel wall after

administration of intravenous gadolinium Edema Mural edema Ulcers Presence or ulcers The following formula is used to calculate the MaRIA: MaRIA = (1.5 x wall thickness (mm)) +

(0.02 x relative contrast enhancement) + (5 x edema) + (10 x ulcers)

The global MaRIA score is calculated as the sum of the MaRIA in the ileum, ascending colon, transverse colon, descending colon, sigmoid, and rectum. Rimola J, Ordas I, Rodriguez S, et al. Magnetic resonance imaging for evaluation of Crohn’s disease: validation of parameters and severity and quantitative index of activity. Inflammatory Bowel Diseases 2011;17:1759-‐68.



Supplementary Table 26: Van Assche MRI-‐based Score for Severity of Perianal Crohn’s Disease. Feature Grade and description Number of fistula tracts 0 None

1 Single, unbranched 2 Single, branched 3 Multiple

Location 1 Extra-‐ or intersphincteric 2 Transsphincteric 3 Suprasphincteric

Extension 1 Infralevatoric 2 Supralevotoric

Hyperintensity on T2-‐weighted images 0 Absent 4 Mild 8 Pronounced

Collections (cavities >3mm diameter) 0 Absent 4 Present

Rectal wall involvement 0 Normal 2 Thickened

Van Assche G, Vanbeckevoort D, Bielen D, et al. Magnetic resonance imaging of the effects of infliximab on perianal fistulising Crohn’s disease. American Journal of Gastroenterology 2003;98:332-‐339. Reproduced with permission from copyright holder.



Supplementary Table 27: Limberg Score for bowel ultrasound. Limberg Grade Description Grade 0 No bowel wall thickening, no vascularization Grade 1 Bowel wall thickening, no vascularization Grade 2 Bowel wall thickening with short stretches of vascularity Grade 3 Bowel wall thickening with long stretches of vascularity Grade 4 Bowel wall thickening with long stretches of vascularity reaching into

the mesentery The score is devised using Doppler power ultrasound. Normal bowel wall thickness has been defined as ≤4mm. Limberg B. (Diagnosis of chronic inflammatory bowel disease by ultrasonography). Zeitschrift fur Gastroenterologie 1999;37:495-‐508. Drews BH, Barth TF, Hanle MM, et al. Comparison of sonographically measured bowel wall vascularity, histology, and disease activity in Crohn’s disease. European Radiology 2009;19:1379-‐86.

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