Clinical implications of mucosal healing for the management of IBD

• Published in: Nature reviews. Gastroenterology & hepatology Vol. 7; no. 1; pp. 15 - 29
• Main Authors: Colombel, Jean-Frédéric, Pineton de Chambrun, Guillaume, Lémann, Marc, Peyrin-Biroulet, Laurent
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.01.2010; Nature Publishing Group
• Subjects: Anti-Inflammatory Agents - therapeutic use; Biomedicine; Care and treatment; Crohn's disease; Endoscopy, Gastrointestinal - methods; Gastroenterology; Hepatology; Humans; Immunosuppressive Agents - therapeutic use; Inflammatory bowel disease; Inflammatory bowel diseases; Inflammatory Bowel Diseases - pathology; Inflammatory Bowel Diseases - therapy; Intestinal Mucosa - pathology; Medicine; Medicine & Public Health; Patient outcomes; review-article; Treatment Outcome; Ulcerative colitis
• ISSN: 1759-5045; 1759-5053
• DOI: 10.1038/nrgastro.2009.203

Mucosal healing has emerged as an important treatment goal for patients with IBD. This Review article focuses on the definition of mucosal healing, the ability of available IBD medications to induce and maintain mucosal healing, and the influence of mucosal healing on the course of IBD. The article also discusses how best to integrate the treatment end point of mucosal healing into clinical practice for the management of patients with IBD. Mucosal healing (MH) has emerged as an important treatment goal for patients with IBD. Historically, the therapeutic goals of induction and maintenance of clinical remission seemed insufficient to change the natural history of IBD. Evidence has now accumulated to show that MH can alter the course of IBD, as it is associated with sustained clinical remission, and reduced rates of hospitalization and surgical resection. In patients with ulcerative colitis, MH may represent the ultimate therapeutic goal because inflammation is limited to the mucosa. In patients with Crohn's disease, which is a transmural disease, MH could be considered as a minimum therapeutic goal. This Review focuses on the definition of MH and discusses the ability of each available IBD medication to induce and maintain MH. The importance of achieving MH is also discussed and literature that demonstrates improvement of disease course with MH is reviewed. Finally, we discuss how best to integrate the treatment end point of MH into clinical practice for the management of patients with IBD. Key Points The ideal definition of mucosal healing (MH) could be complete endoscopic healing of all inflammatory and ulcerative lesions of the gut mucosa in Crohn's disease (CD) and ulcerative colitis (UC) In CD, an endoscopic response to treatment can be defined as a significant change of endoscopic disease activity score, such as the CDEIS or the SES-CD In UC, MH can be achieved with corticosteroids, 5-aminosalicylates, immunosuppressive drugs and biological agents, and can be maintained with 5-aminosalicylates, immunosuppressive drugs and biological agents In CD, MH can be achieved with corticosteroids, enteral nutrition (in pediatric patients), immunosuppressive drugs and biological agents, and can be maintained with immunosuppressive drugs and biological agents MH is a more objective end point than clinical remission for evaluating inflammatory disease activity and should be used in both therapeutic trials and clinical practice for the management of IBD MH can alter the natural history of IBD by reducing hospitalization rate and the lifetime risk for surgery