A Normal UCEIS Is Zero, not Three: Gastroenterology | March 26

Introduction

The Ulcerative Colitis Endoscopic Index of Severity (UCEIS) was developed to standardise the endoscopic assessment of ulcerative colitis activity. It evaluates vascular pattern, bleeding, and erosions/ulcers, generating a score reflecting disease severity. Although initially described with a range of 3–11, subsequent validation rebased the scoring system to 0–8, making a completely normal colonoscopy score 0. Despite this revision, confusion about the correct scoring persists in clinical practice and literature.

Summary

This commentary highlights ongoing misconceptions regarding the UCEIS scoring system and emphasises the importance of adopting the validated 0–8 scale. The rebasing from 3–11 to 0–8 improved clinical interpretation, so a normal colonoscopy now scores 0 rather than 3. However, surveys among inflammatory bowel disease specialists revealed that over one-third still believe a normal colonoscopy corresponds to a score of 3. Literature review also identified multiple publications, guideline documents, and online calculators continuing to reference the outdated scale. This inconsistency may influence research and clinical decision-making, as UCEIS is increasingly used to guide treatment escalation and predict outcomes, including response to intravenous steroids in acute severe ulcerative colitis. The authors call for universal adoption of the validated scoring system and improved educational resources, including standardised image examples for each descriptor. Establishing a common understanding of UCEIS is essential for reliable communication, accurate disease assessment, and consistency across clinical care and research in ulcerative colitis.