45,55,56 The combination of pANCA+ and ASCA- test may occasionally be helpful in differentiating UC from CD, with improved specificity to 94.3% but lower sensitivity of only 51.3%. In the pediatric population an improved sensitivity of up to 70% was observed.45 The extent of the disease of UC in the Asia Pacific region is similar to that in the West. The extent of disease should be described as proctitis, left sided colitis DAPT ic50 and extensive colitis (Montreal classification—E1, E2, E3). Level of agreement: a-94%, b-6%, c-0%, d-0%, e-0% Quality of evidence: II-2 Classification of recommendation: B Studies from the Asia-Pacific region included

those from South Korea, Japan, Thailand, China, Hong Kong, Singapore and Malaysia attest to fairly similar disease presentation in terms of extent.57–63 Western data from Olmsted county(USA), Norwegian, New Zealand and Australian populations were in keeping with the presentation noted in Asia-Pacific.55,64–66 For purposes of future data collection, the group agreed that the extent of disease should follow the Montreal classification for uniformity. Colonoscopy with ileoscopy and biopsies is preferred over barium enema in the evaluation of extent and severity of UC Level of agreement: Luminespib a-88%, b-6%, c-6%, d-0%,

e-0% Quality of evidence: II-3 Classification of recommendation: B Many studies showed the utility of biopsies to distinguish UC from other colitides.7,67–69 They also show the superiority of colonoscopy and biopsies selleck kinase inhibitor in determining extent and severity.19,68,69 The group agrees with the ASGE 2006 guidelines that colonoscopy and ileoscopy with biopsies are required to evaluate IBD and are useful to differentiate UC from CD. It is important to perform abdominal X-ray (AXR) to exclude toxic megacolon in severe UC Level of agreement:

a-94%, b-6%, c-0%, d-0%, e-0% Quality of evidence: II-3 Classification of recommendation: B There was good agreement that AXR should be done to exclude the complications of toxic megacolon in severe attacks of UC.70,71 The group recognises that serial AXRs are also important in the management of acute severe attacks. Computerized tomographic (CT) scan of the abdomen may also play a role in excluding toxic megacolon. The assessment of UC severity is based on a combination of clinical features (fever, number of liquid stools, bleeding, abdominal pain), vital signs, functional status and objective assessment (laboratory endoscopic features). Level of agreement: a-47%, b-47%, c-6%, d-0%, e-0% Quality of evidence: III Classification of recommendation: C Many activity indexes have been formulated to standardize methods for assessing the activity of disease. These indexes may employ clinical characteristics alone, or with laboratory and/or endoscopic information. Except for a few, many of these indexes have not been validated.