Newer, more comprehensive treatment endpoints in the clinical management of patients with inflammatory bowel disease necessitate a robust, accurate, and reproducible approach during the histologic examination of disease activity in specimens from these patients. Pathologists are increasingly being asked to evaluate and report histologic parameters that will enable more specific and focused treatment decisions in the quest for more complete disease remission. This review will summarize the terminology used, available scoring systems, use context, and appropriate interpretation of findings during this endeavor. Limitations and future concerns in this evolving landscape will also be considered.