Editorial
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World J Gastroenterol. Feb 21, 2013; 19(7): 968-978
Published online Feb 21, 2013. doi: 10.3748/wjg.v19.i7.968
Histological healing in inflammatory bowel disease: A still unfulfilled promise
Vincenzo Villanacci, Elisabetta Antonelli, Karel Geboes, Giovanni Casella, Gabrio Bassotti
Vincenzo Villanacci, Department of Pathology, Spedali Civili of Brescia, 25100 Brescia, Italy
Elisabetta Antonelli, Gabrio Bassotti, Gastroenterology and Hepatology Section, Department of Clinical and Experimental Medicine, University of Perugia, 06156 Perugia, Italy
Karel Geboes, Department of Pathology, University Hospital KU Leuven and UZ Gent, 3000 Leuven, Belgium
Giovanni Casella, Division of Internal Medicine, Desio General Hospital, 20033 Desio, Italy
Author contributions: Bassotti G and Villanacci V designed the research project and wrote the paper; Antonelli E, Geboes K and Casella G critically reviewed the manuscript for important intellectual content; all authors approved the final draft of the manuscript.
Correspondence to: Gabrio Bassotti, Professor, Gastroenterology and Hepatology Section, Department of Clinical and Experimental Medicine, University of Perugia, Ospedale Santa Maria della Misericordia, Piazzale Menghini 1, 06156 Perugia, Italy. gabassot@tin.it
Telephone: +39-75-5784423 Fax: +39-75-5847570
Received: June 27, 2012
Revised: September 11, 2012
Accepted: September 19, 2012
Published online: February 21, 2013
Abstract

Treatment of inflammatory bowel disease (IBD) is traditionally based on several drugs, including salicylates, corticosteroids, and antibiotics; in addition, the therapeutic armamentarium has considerably evolved with the advent of newer, effective therapeutic measures (such as the biological agents) that are able to improve in a considerable manner both the clinical and endoscopic variables. Thus, mucosal healing, at least considered from an endoscopic point of view, is today regarded as the ultimate endpoint for treatment of these conditions. However, it is also increasingly clear that endoscopic healing is not necessarily paralleled by histological healing; There are few doubts that the latter should be considered as a true, objective healing and the ultimate goal to reach when treating patients with IBD. Unfortunately, and surprisingly, only a few, incomplete, and somewhat conflicting data exist on this topic, especially because there is still the need to standardize both histological assessment and the severity grading of these disorders; Issues that have not been yet been resolved for clinical practice and therapeutic trials. Hopefully, with the help of an increased awareness on the clinical researchers’ side, and the availability of dedicated pathologists on the other side, this matter will be effectively faced and resolved in the near future.

Keywords: Crohn’s disease, Healing, Histology, Inflammatory bowel diseases, Ulcerative colitis