Assessing IBD

Assessing IBD2018-09-28T10:53:56+00:00

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Measuring Crohn’s Disease

Harvey-Bradshaw Index

The Harvey-Bradshaw Index consists of a few questions that allow physicians to quickly categorize the severity of Crohn’s disease and detect remission. This index is especially useful for data collection. Harvey and Bradshaw first published the index in The Lancet, in 1980, as a shorter, simpler alternative to the standard categorization technique called the Crohn’s Disease Activity Index. Patients answer the following five questions, and are given a score based on the severity of their symptoms.

 

Harvey-Bradshaw Index Questions

1. Patient’s general well-being (for the previous day)

(0 = very well, 1 = slightly below par, 2 = poor, 3 = very poor, 4 = terrible)

 

2. Abdominal pain (for the previous day)

(0 = none, 1 = mild, 2 = moderate, 3 = severe)

 

3. Number of liquid stools per day (for the previous day)
(score 1 per movement)

 

4. Abdominal mass
(0 = none, 1 = dubious, 2 = definite, 3 = definite and tender)

 

5. Complications (score 1 per item)

  • joint pain (arthralgia)
  • inflammation of the middle layer of the eye (uveitis)
  • inflammation of fat cells that results in tender red nodules on shins (erythema nodosum)
  • ulcers in the mouth (aphthous ulcers)
  • condition that causes tissue to become necrotic (pyoderma gangrenosum)
  • tear in the tissue that lines the anus (anal fissure)
  • a newly formed channel between the end of the bowel and the skin around the anus (fistula)
  • swollen tissue with an accumulation of pus (abscess)

 

Harvey-Bradshaw Index Score

Remission: <5
Mild Disease: 5 to 7
Moderate Disease: 8 to 16
Severe Disease: >16

 

Assessment for Ulcerative Colitis Activity

Partial Mayo Scoring Index

The Partial Mayo Scoring Index is similar to the Harvey-Bradshaw Index, but instead of measuring Crohn’s disease it measures ulcerative colitis. The Partial Mayo Scoring Index consists of a few questions for the patient to answer, and one question for the physician to answer. The numerical results provide a score that represents an estimate of ulcerative colitis disease severity.

 

Patients complete these questions:

Number of daily bowel movements you have when in remission/number of daily bowel movements you had before your diagnosis or symptoms of ulcerative colitis began (this number will be Your Normal):

 
1. Stool Frequency (based on the past 3 days)

  • normal number of stools = 0
  • 1-2 stools more than normal = 1
  • 3-4 stools more than normal = 2
  • 5 or more stools more than normal = 3

 

2. Rectal Bleeding (based on the past 3 days)

  • no blood seen = 0
  • streaks of blood with stool less than half the time = 1
  • obvious blood with stool most of the time = 2
  • blood alone passed = 3

 

Physician completes this question:

3. Physician’s Global Assessment*

  • normal (sub scores are mostly 0) = 0
  • mild disease (sub scores are mostly 1) = 1
  • moderate disease (sub scores are mostly 1 to 2) = 2
  • severe disease (sub scores are mostly 2 to 3) = 3

*The physician’s Global Assessment acknowledges the sub scores, the daily record of abdominal discomfort and functional assessment and other observations such as physical findings, and the patient’s performance status.

 

Total Partial Mayo Index Score

Remission: 0-1
Mild Disease: 2-4
Moderate Disease: 5-6
Severe Disease:7-9


First published in the Inside Tract® newsletter issue 198 – 2016
Harvey RF, Bradshaw JM. A simple index of Crohn’s-disease activity. Lancet. 1980 Mar 8;1(8167):514.
Lewis JD et al. Use of the Non-invasive Components of the Mayo Score to Assess Clinical Response in Ulcerative Colitis. Inflamm Bowel Dis;14(12):1660–1666.