title: Assessment of mucosal healing in inflammatory bowel disease: review.
abstract: OBJECTIVE
  Mucosal healing is an important treatment end-point in inflammatory bowel disease, and achieving mucosal healing has been demonstrated to improve disease-related outcomes. Considerable uncertainty exists, however, regarding the optimal approach for the assessment of mucosal healing.
  
  
  OBJECTIVE
  To compare currently available diagnostic tools for the assessment of mucosal healing and outline the ideal approach to integrating these tools into clinical trials and clinical practice.
  
  
  METHODS
  Review article.
  
  
  RESULTS
  Endoscopy represents the criterion standard for the assessment of mucosal healing, and frequent endoscopic assessment is associated with a higher rate of achieving mucosal healing. The use of mucosal biopsy allows for the identification of persistent histologic disease activity, but the incremental clinical benefit of achieving histologic healing is yet to be determined. Magnetic resonance enterography has a high sensitivity for ulcer healing in endoscopically inaccessible disease activity. However, the presence of mucosal lesions cannot be reliably excluded based on this modality alone, and further small-bowel endoscopy should be considered in symptomatic patients. Video capsule endoscopy or device-assisted enteroscopy can be used, with device-assisted enteroscopy being preferred in stricturing Crohn's disease because of the risk of capsule retention or in patients in whom small-bowel malignancy is a possibility.
  
  
  CONCLUSIONS
  Endoscopy remains the criterion standard for the assessment of mucosal healing. Several alternative diagnostic modalities have become available that can be of value in specific clinical circumstances, particularly in patients with small-bowel involvement.
authors.affiliation: University of California San Diego, San Diego, California; Robarts Clinical Trials, Robarts Research Institute, Western University, London, Ontario, Canada.
authors.forename: Parambir S
authors.initials: PS
authors.lastname: Dulai
authors.affiliation: University of California San Diego, San Diego, California; Robarts Clinical Trials, Robarts Research Institute, Western University, London, Ontario, Canada.
authors.forename: Barrett G
authors.initials: BG
authors.lastname: Levesque
authors.affiliation: Robarts Clinical Trials, Robarts Research Institute, Western University, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada.
authors.forename: Brian G
authors.initials: BG
authors.lastname: Feagan
authors.affiliation: Robarts Clinical Trials, Robarts Research Institute, Western University, London, Ontario, Canada; Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Geert
authors.initials: G
authors.lastname: D'Haens
authors.affiliation: University of California San Diego, San Diego, California; Robarts Clinical Trials, Robarts Research Institute, Western University, London, Ontario, Canada.
authors.forename: William J
authors.initials: WJ
authors.lastname: Sandborn
mesh_terms: D053704:Capsule Endoscopy; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy / Q000473:pathology*; D007413:Intestinal Mucosa / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D012720:Severity of Illness Index; D014945:Wound Healing