Mucosal healing in Crohn's disease and ulcerative colitis: what does it tell us?

PURPOSE OF REVIEW: To provide a critical review of the literature concerning the significance of mucosal healing as a predictor of future clinical and endoscopic course in patients with inflammatory bowel disease. Particular focus is given to articles published within the last year.

RECENT FINDINGS: In patients with Crohn's disease, mucosal healing appears to predict future endoscopic activity. The ability to predict future clinical activity is uncertain, likely limited by present techniques for assessment of clinical activity. Recent studies provide support for escalation of treatment in response to ongoing endoscopic disease activity. However, guidance regarding de-escalation of medical therapy is lacking. In patients with ulcerative colitis, mucosal healing appears to be an important predictor of future endoscopic and clinical activity. Recent evidence suggests that mucosal healing is also an important predictor of long-term outcomes such as need for future colectomy.

SUMMARY: Assessment of mucosal healing is an important tool in the management of patients with inflammatory bowel disease. The pursuit of endoscopic remission has a clear role in the management of patients with ulcerative colitis, but the application of this parameter to the care of patients with Crohn's disease requires further research.