Mucosal healing as an index of colitis activity: Back to histological healing for future indices

Beyond endoscopic mucosal healing in UC: histological remission better predicts corticosteroid use and hospitalisation over 6 years of follow-up

“…Histological remission as a marker of ‘complete’ remission was shown to be of more value than endoscopic remission in predicting requirement for corticosteroids or hospitalisation for acute severe colitis over the 6-year follow-up. The findings are striking but intuitive, adding weight to calls to include histological remission into definitions of the depth of remission for UC 17 43 44. In the current scramble for biomarkers that might predict the future pattern of disease, traditional measures such as histology merit re-appraisal.…”

Systematic review: Histological remission in inflammatory bowel disease. Is ‘complete’ remission the new treatment paradigm? An IOIBD initiative

“…2,[39][40][41][42][43][44] Unfortunately, the terms histological 'healing' and 'remission' appear interchangeable, although they are not necessarily synonymous. 17,40,45,46 The term 'mucosal healing' is unclear with regard to cells that are, or are no longer, present or change their number or proportion, and needs to be separated from endoscopic healing. Furthermore, the emerging concept of 'deep remission' in CD, defined as 'clinical remission' (a CDAI b 150 merits the inverted commas) and endoscopic healing without ulceration, does not include histopathology, 47,48 which sheds light on all other cellular elements short of overt ulceration.…”

“…[17][18][19] Persistent microscopic inflammation, both acute and chronic, in patients with ulcerative colitis (UC) has been associated with increased relapse rates, hospitalization, colectomy and risk of colorectal neoplasia. 18,[20][21][22][23][24][25][26][27] Despite the intuitive importance of microscopic activity as the harbinger of visible disease and clinical relapse, histological remission has yet to be recommended as a therapeutic endpoint for clinical trials or practice in IBD.…”

Comparing histological activity indexes in UC

“…Accumulating evidence indicates that histological healing may be associated with better clinical outcomes in UC and could represent the ultimate therapeutic goal in UC 4 5. Acute inflammatory indicators are associated with a twofold to threefold increased risk of colitis relapse during 12-month follow-up6 and basal plasmocytosis predicts UC clinical relapse in patients with complete mucosal healing 7.…”