Editorial
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2024; 30(13): 1801-1809
Published online Apr 7, 2024. doi: 10.3748/wjg.v30.i13.1801
Disease clearance in ulcerative colitis: A new therapeutic target for the future
Syed Adeel Hassan, Neeraj Kapur, Fahad Sheikh, Anam Fahad, Somia Jamal
Syed Adeel Hassan, Neeraj Kapur, Division of Digestive Disease and Nutrition, University of Kentucky, Lexington, KY 40536, United States
Fahad Sheikh, Department of Pathology and Laboratory Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10461, United States
Anam Fahad, Division of Primary Care, Essen Healthcare, New York, NY 10457, United States
Somia Jamal, Department of Internal Medicine, Karachi Medical and Dental College, Karachi 74700, Sindh, Pakistan
Author contributions: Hassan SA, Kapur N designed the overall content of the study; Hassan SA, Kapur N, Sheikh F, and Fahad A contributed to the writing of the manuscript; Sheikh F and Fahad A contributed to the literature review; Jamal S contributed to the generation of manuscript figure and literature review. All authors have read and approved the final manuscript.
Conflict-of-interest statement: All authors of this manuscript do not have any conflict-of-interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Syed Adeel Hassan, MBBS, MD, Research Scientist, Division of Digestive Disease and Nutrition, University of Kentucky, 800 Rose Street, Lexington, KY 40536, United States. doc.syed92@gmail.com
Received: January 6, 2024
Peer-review started: January 6, 2024
First decision: February 6, 2024
Revised: February 16, 2024
Accepted: March 19, 2024
Article in press: March 19, 2024
Published online: April 7, 2024
Processing time: 87 Days and 19.9 Hours
Abstract

Advancements in murine modeling systems for ulcerative colitis have diversified our understanding of the pathophysiological factors involved in disease onset and progression. This has fueled the identification of molecular targets, resulting in a rapidly expanding therapeutic armamentarium. Subsequently, management strategies have evolved from symptomatic resolution to well-defined objective endpoints, including clinical remission, endoscopic remission and mucosal healing. While the incorporation of these assessment modalities has permitted targeted intervention in the context of a natural disease history and the prevention of complications, studies have consistently depicted discrepancies associated with ascertaining disease status through clinical and endoscopic measures. Current recommendations lack consideration of histological healing. The simultaneous achievement of clinical, endoscopic, and histologic remission has not been fully investigated. This has laid the groundwork for a novel therapeutic outcome termed disease clearance (DC). This article summarizes the concept of DC and its current evidence.

Keywords: Inflammatory bowel disease; Ulcerative colitis; Clinical remission; Endoscopic remission; Histological remission; Mucosal healing; Disease clearance

Core Tip: Clinical management of ulcerative colitis is guided by a combination of clinical and endoscopic measures, but histologic healing is undervalued. The current definition of disease remission is insufficient due to discrepancies in outcomes. Disease clearance (DC) is a novel emerging composite outcome defined as the simultaneous attainment of clinical, endoscopic and histologic remission. The risk of disease relapse, hospitalization and surgery is significantly lower in patients who achieve DC. It provides superior optimal disease control in the short term. Large prospective studies are needed to determine the cost effectiveness, risk-benefit ratio and impact on long-term outcomes.