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Monitoring disease activity in inflammatory bowel disease (IBD) is challenging since clinical manifestations do not represent reliable surrogates for an accurate reflection of the inflammatory burden. Endoscopic remission had been the most significant endpoint target in the last years; nevertheless, a remarkable proportion of patients continue to relapse despite a normal-appearing mucosa, highlighting that endoscopy may underestimate the true extent of the disease. A subtle hint of the importance that histology plays in the long-term course of the disease has been endorsed by the STRIDE-II consensus, which recommends considering histologic healing for ulcerative colitis (UC), even though it is not stated to be a compulsory formal target. It is a continuum-changing paradigm, and it is almost a certainty that in the near future, histologic healing may become the new formal target for ulcerative colitis. It must be emphasized that there is great heterogeneity in defining histological remission, and the main criteria or cut-off values for inflammatory markers are still in an ill-defined area. The complexity of some histologic scores is a source of confusion among clinicians and pathologists, leading to low adherence in clinical practice when it comes to a homogenous histopathological report. Therefore, a standardized and more practical approach is urgently needed. [ABSTRACT FROM AUTHOR]

Inflammatory bowel disease (IBD) is a chronic affliction that requires careful regular monitoring and focused treatment, defined by remissions and flares, with frequent hospital admissions, surgical procedures in complicated cases and progression towards dysplasia in longstanding disease. The patient's quality of life is considerably affected by the disease per se but also by the frequent follow-ups and invasive procedures used for disease activity monitoring. The diagnosis of inflammatory bowel disease rests on symptoms, clinical signs, laboratory and imaging tests and is confirmed by bioptic endoscopy with subsequent pathology examination. Endoscopy is an important tool not just for disease diagnosis but also for disease progression monitoring, early dysplastic lesions diagnosis and therapeutic intervention. Endoscopy offers a fast and straightforward evaluation of the colonic mucosa, enabling the description of the extent and severity of the intestinal lesions leading to the prediction of the disease's aggressive nature and the introduction of appropriate treatment. The ultimate goal when dealing with IBDs is to reach mucosal healing, thus ensuring a significant improvement of the quality of life and prognosis and a drop in hospitalization expenses and in the need for surgical measures. This paper aims to review the latest Gastrointestinal Endoscopy Society standards of practice guidelines so as to offer a useful algorithm for the use of endoscopy in patient care. [ABSTRACT FROM AUTHOR]