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

Calculators  Gastrointestinal
Mayo Score / Disease Activity Index (DAI) is an important calculator which predicts the severity of occuring Ulcerative colitus.
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
3 points requires patients to have ≥50% of BMs with visible blood AND ≥1 BM with blood alone.
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


Measured Factor
Mayo score
Measured Factor Disease
  • Ulcerative Colitus
Measured Factor Detail
Mayo Score / Disease Activity Index (DAI) helps to assess the severity of ulcerative colitus in patients with acute severe colitis. Mayo score helps in guiding whether to go for colectomy, based on the scores obtained. Lower the mayo score need of colectomy is less and higher mayo score suggests the severity of UC is high and colectomy may required.
Body System
Measured Factor Low Impact
  • A minimum score of 0 indicates the low risk of UC
Measured Factor High Impact
  • A maximum score of 12 indicates the severity of UC is very high and patient need colectomy

Result Interpretation

Ranges Ranges
  • Critical High: 1200%
Result High Conditions
  • Toxic megacolon
  • Blood clots
  • Colorectal cancer
  • Gastrointestinal perforation
  • Primary sclerosing cholangitis
  • Severe bleeding
Test Limitations
Modified Mayo Endoscopic Score is more accurate than the Mayo endiscopic score
References: 2


Study Validation 1
The aim of this retrospective study was to compare the changes occur while using Mayo score and noninvasive 9-point partial Mayo score. Data from 105 patients with ulcerative colitis (UC) who were recruited in a 12-week randomized, placebo-controlled trial was collected. Comparison was done for any change in the Mayo score, the partial Mayo score and in a 6 point score composed of frequency of stool and bleeding variables. Optimal cutpoints were calculated in all scores for each score to assess the improvement of disease. Results showed that all three scores were optimal in diagnosis of Ulcerative colitis
References: 3
Study Validation 2
This aim of this study was to validate Ulcerative Colitis Endoscopic Index of Severity (UCEIS) with an independent group of investigators. 57 videos of flexible sigmoidoscopy were selected based on the severity of disease and 25 investigators were each randomly allocated to assess 28 videos. Parameters observed were vascular patter, bleeding, erosions and ulcers. UCEIS were assigned by investigators to determine the overall sverity. Results showed significant level of correlation among scores and overall assessment of severity. Internal consistency was evaluated by Cronbach α analysis and was 0.86. The overall intrainvestigator and interinvestigator agreement was good and moderate respectively. This study concluded that UCEIS and its variables showed a adequate performance in predicting the severity of UC
References: 4
Study Validation 3
The aim of this prospective observational study was to develop and test an IBD monitoring tool to determine the disease activity with Crohn's disease (CD) or ulcerative colitis (UC). Data from 110 patients was collected using disease-specific questionnaires. Results from questionnaires were then compared with the Index score of 301 patients with CD and 265 patients suffering from UC. CD based parameters observed were stool frequency, abdominal pain, patient well-being, and patient-assessed disease control and in UC patients rectal bleeding was an added parameter remaining were same as in CD patients. Area under receiver operating characteristic values was found to be 0.63 in CD patients while it was 0.82 in CD patients. This study concluded that  as this tool can be used effectively in patients with UC but can’t be used in patients with CD
References: 5
Study Additional 1
It is reported that activation of guanylate cyclase-C (GC-C) and uroguanylin (Ugn) controls the intestinal fluid and electrolyte homeostasis. This study was aimed to evaluate the effect of guanylate cyclase-C (GC-C) on various clinical severities. A total 60 patients with ulcerative colitis and 20 controls were involved in the study. Modified mayo scored (Grade I, II, III) was utilized to evaluate the UC disease index. Quantitative real-time PCR and Western blot techniques were used to measure the expression of GC-C, Gn and Ugn in the colonic mucosa. Results showed that with increase in UC disease index there was decrease in the levels of GC-C, Gn and Ugn expression. This study concluded that GC-C signaling pathway can be further evaluated in the progression of UC.
References: 6
Study Additional 2
The aim of this retrospective study was to investigate the prevalence of extra gastrointestinal manifestations (EGIMs) in patients with UC with their association to disease. A total of 100 patients with UC were studied from 2009 to 2010 in Iraq. History of the disease, its severity and the presence or absence of the extraintestinal manifestations was determined through interview and clinical lab tests. EGIMs were seen in 17 patients (peripheral arthritis and mouth ulcer) which were more prevalent in patients having severe disease. This study concluded that there was a relation between EGIMs with disease activity
References: 7


  1. Schroeder KW, Tremaine WJ, Ilstrup DM. Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study. N Engl J Med. 1987;317(26):1625-9.
  2. Lobatón T, Bessissow T, De Hertogh G, Lemmens B, Maedler C, Van Assche G, et al. The Modified Mayo Endoscopic Score (MMES): a new index for the assessment of extension and severity of endoscopic activity in ulcerative colitis patients. Journal of Crohn's and Colitis. 2015 Jun 26;9(10):846-52.
  3. Jitsumura M, Kokelaar RF, Harris DA. Remission endpoints in ulcerative colitis: A systematic review. World Journal of Meta-Analysis. 2017 Aug 26;5(4):85-102.
  4. Lewis JD, Chuai S, Nessel L, Lichtenstein GR, Aberra FN, Ellenberg JH. Use of the noninvasive components of the Mayo score to assess clinical response in ulcerative colitis. Inflamm Bowel Dis. 2008;14(12):1660-6.
  5. Van deen WK, Van der meulen-de jong AE, Parekh NK, Kane E, Zand A, DiNicola CA, et al. Development and Validation of an Inflammatory Bowel Diseases Monitoring Index for Use With Mobile Health Technologies. Clin Gastroenterol Hepatol. 2016;14(12):1742-1750.e7.
  6. Lan D, Niu J, Miao J, Dong X, Wang H, Yang G, et al. Expression of guanylate cyclase-C, guanylin, and uroguanylin is downregulated proportionally to the ulcerative colitis disease activity index. Sci Rep. 2016;6:25034.
  7. Al-Khazraji KA. Descriptive study of Extragastrointestinal Manifestations of Ulcerative Colitis and their relation to disease activity in 100 Iraqi patients. Journal of the Faculty of Medicine. 2011;53(1):24-8.

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