Abstract Background Histologic assessment in Crohn’s disease (CD) is challenged by discontinuouslesions and variable biopsy sampling. This study aimed to compare three histiologic scores (HS) and evaluate their agreement with the simple endoscopic score for Crohn’s disease (SES-CD). Methods A cross-sectional analysis was performed using the institutional UR-CARE Registry. For each CD patient, the most recent histopathology report and corresponding endoscopic data were retrieved. Histologic features were recorded, and three HS were calculated for the terminal ileum and colon. The DCA score evaluates Distribution, Chronicity, and Activity (0–2 each) and was categorized as 0 (D0), 1 (C1A0), 2 (C2A0), 3 (A1), and 4 (A2). The Nancy Histological Index (NHI) (0–4) reflects neutrophil presence and degree of mucosal injury. The Global Histologic Activity Score (GHAS) grades six features (0–18) and was grouped as GHAS(c) 0–3. Statistical significance was p 0.05. Results A total of 359 patients were included. The cohort included 182 female patients (50.7%). The median age was 38 years, while the median age at diagnosis was 23 years. All three HS showed significant correlations (r = 0.57–0.91), with the strongest between NHI and DCA in both the terminal ileum and colon (r = 0.88 and r = 0.91). Agreement analysis showed substantial concordance between NHI and DCA (ileum κ = 0.77, colon κ = 0.78), while other score pairs demonstrated moderate to fair agreement (κ = 0.25–0.58), indicating that the indices assess related but not identical features. Score distributions differed across HS, but NHI, DCA, and GHAS(c)—the three with similar ordinal structure—showed the most consistent comparisons. In the terminal ileum, DCA scores exceeded NHI, while GHAS(c) aligned with Nancy and was slightly lower than DCA. In the colon, DCA and GHAS(c) were higher than NHI, and GHAS(c) exceeded DCA. All HS correlated with SES-CD (r = 0.52–0.63), with NHI showing the highest concordance (κ = 0.47). Conclusion Histologic scoring systems in Crohn’s disease are correlated but capture different aspects of mucosal inflammation and are only partly interchangeable. Among them, NHI shows the highest concordance with both DCA and endoscopic activity, indicating it may offer the most reliable assessment across intestinal segments. References: 1.Marion L, Amélie B, Zoubir D, et al. Histological Indices and Risk of Recurrence in Crohn’s Disease: A Retrospective Study of a Cohort of Patients in Endoscopic Remission. Inflamm Bowel Dis. 2022;28(9):1395-1404. 2.Lang-Schwarz C, Angeloni M, Agaimy A, et al. Validation of the ‘Inflammatory Bowel Disease-Distribution, Chronicity, Activity IBD-DCA Score’ for Ulcerative Colitis and Crohńs Disease. J Crohns Colitis. 2021;15(10):1621-1630. 3.Vespa E, D’Amico F, Sollai M, et al. Histological Scores in Patients with Inflammatory Bowel Diseases: The state of the Art. J Clin Med. 2022;11(4):939. Conflict of interest: Putniković, Dunja: Janković, Radmila: No conflict of interest Ocepek, Andreja: No conflict of interest Nikolic, Sara: No conflict of interest
Putniković et al. (2026) studied this question.