Mayo Score/Disease Activity Index (DAI) for Ulcerative Colitis

Why Use

Assesses initial disease severity, change in activity over time, and response to treatment. Provides a universal metric to encapsulate disease severity at a given time in a single number. Similar calcs: Nearly identical to the UC Disease Activity Index (DAI) devised by Sutherland et al . Both scores were released in 1987 as objective measures to examine the effects of salicylates in UC. Both rely on the same 4 categories but have miniscule differences in their point assignments

When to Use

Patients with known ulcerative colitis, particularly when considering changing, adding, or stopping a UC medication; this is not a tool to diagnose ulcerative colitis. The Mayo Score is the most commonly used scoring system for UC in clinical trials and routine practice ( Paine 2014 ).

Formula

Pearls / Pitfalls

The Mayo Score for Ulcerative Colitis was developed to standardize the severity of a patient's ulcerative colitis (UC) symptoms, which is particularly helpful to assess response to treatment over time. The Mayo Score for Ulcerative Colitis was originally devised in 1987 for a clinical trial for pH dependent 5-ASA (Asacol) at the Mayo Clinic. Comprised of 4 parts: stool frequency, rectal bleeding, endoscopic findings and physician’s global assessment, each scored from 0-3. The physician’s global assessment accounts for other signs/symptoms including abdominal pain, physical exam findings (extraintestinal manifestations, fever, tachycardia), functional status, and the patient’s overall sense of well being. Total scores range from 0-12 with higher scores indicating increased severity of disease. Response to therapy is defined differently in each trial, but most use a decrease of 3 or more points. Remission is often defined as a total score of 2 or less with all individual categories ≤1. Occasionally, remission is defined stringently as a score of 0. Most clinical trials define mucosal healing as an endoscopic score of 0 or 1, although numerous other endoscopic scoring systems exist (D’Haens 20074). The “Full” or “Complete” Mayo score incorporates all 4 parts. If endoscopic findings are not available, the remaining 3 categories constitute a “Modified” or “Partial” Mayo score. Points to keep in mind: For stool frequency and rectal bleeding, the patient acts as their own point of reference (i.e. number of stools above normal ) rather than the absolute number. Critics point out an element of subjectivity in the Physician’s Global Assessment (sense of well being). The score is not designed to predict need for admission or surgical therapy. This is not a tool to diagnose ulcerative colitis, rather a tool to evaluate patients with known UC.

Critical Actions

If endoscopic data are not available, the modified Mayo score performs equally well. ( Lewis 2008 )

Advice

Not designed to predict need for admission or surgical therapy However, an endoscopic score of 0 is associated with lower risk of colectomy compared to higher scores. ( Manginot 2016 )

More Information

Criteria Point Value Stool Frequency Normal 0 1–2 stools/day more than normal +1 3–4 stools/day more than normal +2 >4 stools/day more than normal +3 Rectal bleeding* None 0 Visible blood with stool less than half the time +1 Visible blood with stool half of the time or more +2 Passing blood alone +3 Mucosal appearance at endoscopy Normal or inactive disease 0 Mild disease (erythema, decreased vascular pattern, mild friability) +1 Moderate disease (marked erythema, absent vascular pattern, friability, erosions) +2 Severe disease (spontaneous bleeding, ulceration) +3 Physician rating of disease activity Normal 0 Mild +1 Moderate +2 Severe +3 *Assigning a score of 3 requires patients to have ≥50% of bowel movement accompanied by visible blood and 1+ bowel movement with blood alone. Score interpretation: The higher the score, the more severe the case of ulcerative colitis. The highest score possible is a 12. Scores should be compared to previous scores taken for a patient. The mucosal appearance at endoscopy is not included in the Partial Mayo Score.