Krishnan A, Mukherjee D. Challenges and limitations in assessing mucosal healing in Crohn’s disease: Discrepancies between endoscopic and histologic evaluations. World J Gastrointest Endosc 2025; 17(3): 103834 [DOI: 10.4253/wjge.v17.i3.103834]
Corresponding Author of This Article
Arunkumar Krishnan, MD, Assistant Professor, Department of Supportive Oncology, Atrium Health Levine Cancer, 1021 Morehead Medical Drive, Suite 70100, Charlotte, NC 28204, United States. dr.arunkumar.krishnan@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Mar 16, 2025; 17(3): 103834 Published online Mar 16, 2025. doi: 10.4253/wjge.v17.i3.103834
Challenges and limitations in assessing mucosal healing in Crohn’s disease: Discrepancies between endoscopic and histologic evaluations
Arunkumar Krishnan, Diptasree Mukherjee
Arunkumar Krishnan, Department of Supportive Oncology, Atrium Health Levine Cancer, Charlotte, NC 28204, United States
Diptasree Mukherjee, Department of Biochemistry, All India Institute of Medical Sciences, Bhubaneswar 751019, Odisha, India
Author contributions: Krishnan A contributed to the concept of the study; Krishnan A and Mukherjee D drafted the manuscript, participated in the review and editing, and were involved with critically revising the manuscript for important intellectual content; and all authors reviewed and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: Arunkumar Krishnan, MD, Assistant Professor, Department of Supportive Oncology, Atrium Health Levine Cancer, 1021 Morehead Medical Drive, Suite 70100, Charlotte, NC 28204, United States. dr.arunkumar.krishnan@gmail.com
Received: December 2, 2024 Revised: January 29, 2025 Accepted: February 12, 2025 Published online: March 16, 2025 Processing time: 102 Days and 7.3 Hours
Abstract
The recent study published by Lee et al examined the discrepancies between endoscopic and histologic evaluations of mucosal inflammation in active ileal Crohn’s disease (CD). While this research contributes to our understanding of the limitations of current biopsy protocols, it raises several concerns about the generalizability of its findings, sample size, and methodology. One major limitation was the exclusion of patients with ileal strictures, ileostomies, or J-pouches, which reduced the applicability of the results to the wider CD population. Furthermore, the biopsy protocol's focus on single biopsies from specific locations may inadequately capture the patchy inflammation characteristic of CD. The study also uses histologic indices primarily developed for ulcerative colitis, which may not be suitable for assessing CD. It is recommended that multi-center studies be conducted and histologic indices specific to CD be developed to improve the relevance of future research. Additionally, researchers should consider the influence of treatment regimens on the findings. Addressing these limitations would enhance the clinical significance of the study and inform better diagnostic and therapeutic approaches for CD.
Core Tip: The recent study by Lee et al showed a significant discrepancy between endoscopic and histologic assessments in patients with ileal Crohn’s disease. However, the generalizability of these findings may be limited due to certain factors, such as the exclusion of specific patient groups, the single-center design of the study, and the potential under-sampling of inflammation. Future research should prioritize multi-center studies, creating Crohn’s specific histologic indices, and considering treatment regimen effects to improve our understanding and improve biopsy protocols for Crohn’s disease.
