Histologic Remission: The Ultimate Therapeutic Goal in Ulcerative Colitis?

Abstract

Ulcerative colitis (UC) is a disease of the mucosal layer, and activity of the disease is assumed to be related to mucosal appearance. Mucosal healing has emerged as a major therapeutic goal in UC. Whether mucosal healing should be the ultimate therapeutic goal in these patients is unknown. Even when endoscopy suggests mucosal healing, evidence of histologic activity has been observed. Histologic healing requires complete recovery of the colonic mucosa, with absence of inflammation or structural changes. Histologic improvements have been linked with improved clinical outcomes, such as a reduced risk of relapse and need for surgery/hospitalization and a reduced risk of developing cancer. Hence, there is a rationale for aiming for histologic remission in UC. Numerous methods of classification of histologic activity in UC have been proposed, although only some of these are widely used. We review the current definitions of histologic remission, the range of scoring systems most commonly used, and the evidence of histologic improvement that is available from the latest therapies for UC. We also highlight questions that will require careful consideration if histologic remission is to become more widely used as an end point in clinical trials and a treatment goal in clinical practice.

Possible under-treatment of women in Poland with Crohn’s disease: a subgroup analysis from a prospective multicenter study of the use of anti-TNFs

“…The final sample included 256 patients (113 women [44.1%] INTRODUCTION Anti-tumor necrosis factor (anti -TNF) antibodies improve the quality of life in patients with inflammatory bowel disease (IBD) 1 and likely modify the course of the disease via mucosal healing and a reduced rate of surgeries. [2][3][4][5][6][7] With an acceptable adverse event profile, TNF inhibitors can be considered the safest and most effective therapy for IBD. 8 The earlier in the course of the disease the anti -TNF treatment is introduced, the higher the probability of response and long -term remission.…”

Treatment Targets in Inflammatory Bowel Disease: Current Status in Daily Practice

“…In UC, varying data on achieving MH with the use of 5-ASA (36,9%-80%) [31,32], azathioprine (53%) [33] and biologics 32%-62% [34][35][36][37] exist, depending on the used definition of MH and duration of follow up. In the case of CD similar results for budesonide (24%) [38], azathioprine (16.5-73%) [38][39][40], combinations of azathioprine and biologics (43,.4%) [39,40], and biologics (20%-63%) [39][40][41][42] exist.…”

“…Newly defined treatment targets, such as deep or histological remission come from endpoints defined for clinical IBD trials [40,[43][44], but are not widely accepted or integrated in the IBD guidelines [25][26][27][28]. Surprisingly, almost half of all respondents used deep remission as a key treatment target in daily clinical practice, which suggests that practice is being shaped prior to development or revision of guidelines.…”

Assessment of Mucosal Healing in Inflammatory Bowel Disease

“…Accumulated evidence indicates that persistent histological disease is associated with an increased risk of hospitalization, colectomy, relapse, and colorectal neoplasia [19][20][21]. Thus, some authors have suggested that histological healing may be the ultimate therapeutic goal especially in UC [22].…”