title: Feasibility of endoscopic assessment and treating to target to achieve mucosal healing in ulcerative colitis.
abstract: BACKGROUND
  Mucosal healing (MH) as a treatment target for ulcerative colitis is of growing interest because it is associated with improved clinical outcomes. However, the feasibility and probability of reaching MH in clinical practice is unknown. We therefore evaluated the feasibility of "treating to target" according to endoscopic findings to reach MH.
  
  
  METHODS
  All endoscopic outcomes of patients with ulcerative colitis followed in a single inflammatory bowel disease unit from 2011 to 2012 were reviewed and subsequent therapeutic management. Cumulative incidence of MH and histologic healing (HH) were estimated using a Kaplan-Meier method.
  
  
  RESULTS
  A total of 60 patients underwent at least 2 consecutive endoscopic assessments, of whom 45 and 48 patients had endoscopic and histologic evidence of active disease, respectively. After a median follow-up of 76 weeks, 27 of 45 (60%) patients with endoscopic disease activity at baseline achieved MH and 24 (50%) of 48 patients with histologic disease activity at baseline had HH. The cumulative probabilities of MH were 26%, 52%, and 70% at 26, 52, and 76 weeks, respectively. The cumulative probabilities of HH at weeks 26, 52, and 76 from the time of initial procedure were 19%, 41%, and 57%, respectively. Any adjustment in medical therapy in case of persistent endoscopic activity was associated with both MH and HH.
  
  
  CONCLUSIONS
  Repeated assessment of endoscopic disease activity with adjustment of medical therapy to the target of MH is feasible in clinical practice in patients with ulcerative colitis, and seems to be of benefit.
authors.affiliation: *Division of Gastroenterology, University of California San Diego, San Diego, California; and †Department of Hepato-Gastroenterology, University Hospital of Rennes, Pontchaillou, Inserm U991 University of Rennes 1, Rennes, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Bouguen
authors.forename: Barrett G
authors.initials: BG
authors.lastname: Levesque
authors.forename: Suresh
authors.initials: S
authors.lastname: Pola
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Evans
authors.forename: William J
authors.initials: WJ
authors.lastname: Sandborn
mesh_terms: D000328:Adult; D003093:Colitis, Ulcerative / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014945:Wound Healing