Mucosal healing and deep remission: What does it mean?

Abstract

The use of specific terms under different meanings and varying definitions has always been a source of confusion in science. When we point our efforts towards an evidence based medicine for inflammatory bowel diseases (IBD) the same is true: Terms such as “mucosal healing” or “deep remission” as endpoints in clinical trials or treatment goals in daily patient care may contribute to misconceptions if meanings change over time or definitions are altered. It appears to be useful to first have a look at the development of terms and their definitions, to assess their intrinsic and context-independent problems and then to analyze the different relevance in present-day clinical studies and trials. The purpose of such an attempt would be to gain clearer insights into the true impact of the clinical findings behind the terms. It may also lead to a better defined use of those terms for future studies. The terms “mucosal healing” and “deep remission” have been introduced in recent years as new therapeutic targets in the treatment of IBD patients. Several clinical trials, cohort studies or inception cohorts provided data that the long term disease course is better, when mucosal healing is achieved. However, it is still unclear whether continued or increased therapeutic measures will aid or improve mucosal healing for patients in clinical remission. Clinical trials are under way to answer this question. Attention should be paid to clearly address what levels of IBD activity are looked at. In the present review article authors aim to summarize the current evidence available on mucosal healing and deep remission and try to highlight their value and position in the everyday decision making for gastroenterologists.

Keywords: Inflammatory bowel disease; Mucosal healing; Deep remission; Treatment targets; Clinical activity

Core tip:“Mucosal healing” and “deep remission” have been discussed heavily as “new” treatment goals in inflammatory bowel diseases patients in recent years. This was based on evidence that the long term disease behaviour appears to be better, when mucosal healing is achieved. Unfortunately, a definite proof that therapy escalation for patients in clinical remission not achieving mucosal healing will be beneficial is still lacking. Clinical trials are under way to answer this question. At the moment it appears to be helpful to summarize the current evidence available on mucosal healing and deep remission to support the everyday decision making for gastroenterologists.