An overview of a presentation by Associate Professor David Rubin from the University of Chicago, USA, at the Raising Expectations in Gastroenterology symposium, 2011.

Endoscopic mucosal healing in inflammatory bowel disease (IBD) is associated with lower rates of relapse and reduced requirement for corticosteroid use, hospitalisation and surgery. 'Deep remission', a combination of clinical remission and mucosal healing, is increasingly becoming recognised as an aim of treatment.

Outcomes associated with mucosal healing

There is considerable evidence for the benefits of mucosal healing:

  • In the ACCENT 1 study, Crohn's disease patients randomised to infliximab therapy had a trend towards fewer hospital admissions. Mucosal healing at week 54 was identified in 46% of patients treated with infliximab1
  • In an observational cohort pre-dating the use of biologic therapies, mucosal healing in ulcerative colitis was associated with a reduction in the risk of colectomy after 1 year (81% vs 19%. p<0.02)2
  • In a study of ulcerative colitis patients receiving mesalazine for 1 year, significantly fewer patients achieving clinical and endoscopic remission relapsed compared to patients achieving clinical remission alone (23% vs 80%, p<0.0001)3
  • Persistent histological inflammation has been associated with an increased risk of cancer and dysplasia in ulcerative colitis4
  • In a patient cohort from Leuven, Belgium, mucosal healing predicted a sustained clinical benefit from infliximab maintenance therapy and less need for major abdominal surgery5
  • The 'Step-up vs top-down' study found that mucosal healing was associated with remission at years 3 and 46

There are a number of challenges in adopting mucosal healing as a target in clinical practice including the lack of resolution on the definition of 'healing', the costs of assessing healing, and the inconvenience and risk to patients of repeated endoscopies. Non-invasive surrogate markers of active IBD, such as faecal calprotectin, are currently being investigated, but are not yet appropriate for routine use.

Summary

  • Mucosal healing is a sign of disease control or resolution
  • There is considerable evidence for the benefits of mucosal healing
  • Mucosal healing is increasingly recognised as an aim of treatment, but practical challenges may hamper its widespread adoption into clinical practice

Please note, the views expressed in this article are not necessarily those of the sponsor.

References

  1. Rutgeerts P et al. Scheduled maintenance treatment with infliximab is superior to episodic treatment for the healing of mucosal ulceration associated with Crohn's disease. Gastrointestinal Endoscopy 2006; 63: 433-442.
  2. Frøslie KF et al. Mucosal healing in inflammatory bowel disease: results from a Norwegian population-based cohort. Gastroenterology 2007; 133: 412–422.
  3. Meucci G et al. Prognostic significance of endoscopic remission in patients with active ulcerative colitis treated with oral and topical mesalazine: a prospective, multicenter study. Inflammatory Bowel Diseases 2012; 18: 1006–1010.
  4. Rutter M et al. Severity of inflammation is a risk factor for colorectal neoplasia in ulcerative colitis. Gastroenterology 2004; 126: 451-459.
  5. Dignass A et al. The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: Current management. Journal of Crohn’s & Colitis 2010; 4: 28–62.
  6. Baert F et al. Mucosal healing predicts sustained clinical remission in patients with early-stage Crohn's disease. Gastroenterology 2010; 138: 463–468.

PBS information: This product is listed as a Section 100 item for Crohn’s disease and ulcerative colitis. Refer to PBS Schedule for full authority information.

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