Definition and evaluation of mucosal healing in clinical practice.
Since the introduction of biological therapy, endoscopic and histological remission, i.e. mucosal healing, has become an important therapeutic goal in Crohn's Disease and Ulcerative Colitis. Mucosal healing is associated with lower rates of hospitalization and surgery, although its role in preventing progression and changing the natural history of the disease has not been clearly demonstrated. A precise definition of mucosal healing has not yet been established, although the concept used in clinical trials is the "complete absence of all inflammatory and ulcerative lesions in all segments of gut" at endoscopy. This definition does not include mucosal improvement and does not distinguish among grades of mucosal healing. In both Crohn's Disease and Ulcerative Colitis trials, several qualitative and quantitative numeric endoscopic indices have been proposed to measure and distinguish endoscopic changes. In addition, the microscopic features associated with inflammatory bowel diseases are considerably modified by the course of the disease and the treatments adopted. However, it is not yet clear whether microscopic healing should be a primary endpoint in clinical trials. In this paper we discuss endoscopic and histological findings and the limitations of the endoscopic and histological indices as a basis for a standardised diagnosis of mucosal healing.
Gastroenterology and Artificial Nutrition Department, "San Nicola Pellegrino" Hospital Trani, BT, Italy.
Silvia
S
Mazzuoli
Francesco W
FW
Guglielmi
Elisabetta
E
Antonelli
Marianna
M
Salemme
Gabrio
G
Bassotti
Vincenzo
V
Villanacci
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001691:Biological Therapy; D003093:Colitis, Ulcerative / Q000473:pathology*; D003424:Crohn Disease / Q000188:drug therapy / Q000473:pathology*; D016099:Endoscopy, Gastrointestinal; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007413:Intestinal Mucosa / Q000473:pathology*; D012459:Salicylates / Q000627:therapeutic use; D012720:Severity of Illness Index; D009626:Terminology as Topic; D014945:Wound Healing
D000305:Adrenal Cortex Hormones; D007155:Immunologic Factors; D012459:Salicylates
Anti-TNFα; CD; CDEIS; Crohn's Disease Digestive Damage Score; Crohn's Disease Endoscopic Index Of Severity; Crohn's disease; Endoscopic index of severity; IBD; Inflammation; Inflammatory bowel disease; MH; Mucosal healing; Pathology; SES-CD; The Lemann score; UC; UCEIS; Ulcerative Colitis Endoscopic Index of Severity; antibody against tumour necrosis factor α; inflammatory bowel disease; mucosal healing; simple endoscopic score for Crohn's disease; ulcerative colitis