John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive


What are the issues surrounding mucosal healing in inflammatory bowel diseases? Volume 18, supplement 5, Septembre 2011

Hôpital Beaujon, Université Paris VII, Pôle des maladies de l’appareil digestif, Service de gastroentérologie, MICI et assistance nutritive, Clichy

Clinical remission, historically considered as the major therapeutic goal in inflammatory bowel disease (IBD), has clearly demonstrated its limitations and its inability to change the natural history of these diseases. On the opposite, endoscopic remission, usually named mucosal healing (MH) is associated with a decreased risk of clinical relapse, hospitalization and surgery both in ulcerative colitis (UC) and Crohn's disease. Thus, MH has emerged as an important treatment goal for patients with IBD. In UC, MH can be achieved and/or maintained with 5-aminosalicylates, immunosuppressive drugs and anti-TNF. In Crohn's disease, can be achieved and/or maintained with immunosuppressive drugs and anti-TNF. In patients with UC, MH could be the ultimate goal of treatment because inflammation is limited to the mucosa. However, in Crohn's disease, which is a transmural affection, MH could be considered as a minimum target to achieve. Thus, MH appears as a more reliable and objective end point than the usual ones for assessing the inflammatory disease activity. It is now integrated in most trials and should be applied in clinical practice for the care of patients. The main question now is how far optimize and/or combine treatments to achieve this goal.