“Mucosal healing” in ulcerative colitis: Between clinical evidence and market suggestion

Abstract

In recent decades, the prominent role of endoscopy in the management of ulcerative colitis (UC) has been translated into the concept of mucosal healing (MH) as a fundamental therapeutic end-point. This is partially the consequence of growing evidence of a positive prognostic role of MH on the disease course and partially due to market cues indicating a higher rate of MH in patients treated by novel potent biologic agents. The aim of the present review is to clarify the current knowledge of MH in UC, analyzing the definition, the putative prognostic role and the association of MH with the current drugs used to treat UC patients. Because solid data about the management of UC patients based solely on the healing of the mucosa are not yet available, a tailored approach for individual patients thatconsiders the natural history of UC and the presence of prognostic indicators of aggressive disease is desirable. Consequently, unnecessary examinations and treatment would be avoided and restricted to UC patients who require the maximum amount of effort to affect the disease course in the short and long term.

Keywords: Ulcerative colitis; Mucosal healing; Prognosis; Evidence

Core tip: In recent years, the concept that the management of ulcerative colitis patients should aim to heal the mucosa rather than resolve symptoms has been decisively proposed. Herein, we review the current evidence supporting this statement and analyze the possible practical implications in the current management of ulcerative colitis patients.