title: Systematic review: histological remission in inflammatory bowel disease. Is 'complete' remission the new treatment paradigm? An IOIBD initiative.
abstract: OBJECTIVE
  Advances in the medical management of inflammatory bowel disease (IBD) have altered treatment targets. Endoscopic mucosal healing is associated with better outcomes in IBD, though less is known about the significance of achieving histological remission. Our aim was to perform a systematic review to investigate whether histological or 'complete' remission constitutes a further therapeutic target in IBD.
  
  
  METHODS
  A bibliographic search was performed on the 1st of October 2013 and subsequently on the 1st of March 2014 of online databases (OVID SP MEDLINE, OVID EMBASE, National Pubmed Central Medline, Cochrane Library, ISI, conference abstracts), using MeSH terms and key words: ("inflammatory bowel diseases" OR "crohn disease" OR "ulcerative colitis" OR "colitis") AND ("mucosal healing" OR "histological healing" OR "pathological healing" OR "histological scoring" OR "pathological scoring").
  
  
  RESULTS
  The search returned 2951 articles. 120 articles were cited in the final analysis. There is no validated definition of histological remission in IBD. There are 22 different histological scoring systems for IBD, none of which are fully validated. Microscopic inflammation persists in 16-100% of cases of endoscopically quiescent disease. There is evidence that histological remission may predict risk of complications in ulcerative colitis beyond endoscopic mucosal healing, though data are scarce in Crohn's disease.
  
  
  CONCLUSIONS
  Histological remission in IBD represents a target distinct from endoscopic mucosal healing, not yet routinely sought in clinical trials or practice. There remains a need for a standardized and validated histological scoring system and to confirm the prognostic value of histological remission as a treatment target in IBD.
authors.affiliation: Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals, United Kingdom.
authors.forename: R V
authors.initials: RV
authors.lastname: Bryant
authors.affiliation: Department of Pathology and Laboratory Medicine, Mt Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Winer
authors.affiliation: Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals, United Kingdom.
authors.forename: S P L
authors.initials: SP
authors.lastname: Travis
authors.affiliation: Department of Pathology and Laboratory Medicine, Mt Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada. Electronic address: rriddell@mtsinai.on.ca.
authors.forename: R H
authors.initials: RH
authors.lastname: Riddell
mesh_terms: D002986:Clinical Trials as Topic; D016099:Endoscopy, Gastrointestinal; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000473:pathology* / Q000628:therapy*; D007413:Intestinal Mucosa / Q000473:pathology*; D011379:Prognosis; D012074:Remission Induction; D014945:Wound Healing
keywords: Histological healing; Histological indices; Histology; Inflammatory bowel disease; Mucosal healing; Ulcerative colitis