Mucosal healing in inflammatory bowel disease: Treatment efficacy and predictive factors

Abstract

In recent years mucosal healing has emerged as an important therapeutic goal for patients with inflammatory bowel disease. Growing evidence suggests that achieving mucosal healing can improve patient outcomes and, potentially, alter the course of the disease. Drugs currently used in the management of inflammatory bowel disease are potentially able of inducing and maintaining mucosal healing, but the effect size is difficult to assess because of different definitions of mucosal healing, differences in study designs, and timing of endoscopic evaluation. Mucosal healing has been studied extensively in the biologic era. Data available from different sources, such as controlled trials and observational studies, show that anti-TNFα therapies can induce rapid and sustained mucosal healing in a variable percentage of patients with Crohn's disease and ulcerative colits. No controlled study has been designed to identify possible predictors of mucosal healing. Some clinical characteristics such as extensive disease, young age at diagnosis, and smoking status may be predictive of a more aggressive clinical course and, presumably, of a reduced clinical and endoscopic response to therapy. Changes and normalization of C-reactive protein and faecal calprotectin may be useful tools to predict outcomes, guide the timing for endoscopic evaluation and, possibly, reduce the need of endoscopic evaluation in assessing mucosal healing.

Rate and Predictors of Endoscopic Mucosal Healing in Biologic Naive Patients with Inflammatory Bowel Disease by Azathioprine Treatment: A Real World, 10 Years’ Experience from a Single Centre in Turkey

“…There are several problems with using EMH in clinical studies, including that mucosal healing may not always be achieved, and that clinical response and mucosal healing may not correlate [1,3,7,[14][15][16]. However, overall EMH is correlated with better and prolonged steroid-free remission, and understanding EMH responses across diverse population groups with standard and newer biologic therapies remains important.…”

“…Although clinical symptoms and quality of life are the key treatment indicators for patients, we chose mucosal healing as the primary treatment end-point of our study given the increasing recognition of its role by IBD physicians [1,4]. There are several problems with using EMH in clinical studies, including that mucosal healing may not always be achieved, and that clinical response and mucosal healing may not correlate [1,3,7,[14][15][16].…”

“…Inflammatory bowel disease (IBD) including Ulcerative Colitis (UC) and Crohn's Disease (CD) are chronic, progressive and relapsing disorders [1]. Both UC and CD are characterized by inflammation and ulceration with genetic and environmental factors that contribute to disease pathogenesis.…”

Mucosal healing as a treatment for IBD?

“…It is difficult to find this ideal setting in a complex and multifactorial disease such IBD and, therefore, surrogate end points could yield misleading conclusions. This is the case for MH: although several drugs are capable of inducing MH in different clinical settings of disease location and severity, the effect size of different treatments and the duration of the effect (short-term or sustained MH) are difficult to assess because of different definitions, different study designs and different timing of endoscopic evaluation [15]. Moreover, current evidence that MH has a high positive predictive value for long-term good clinical outcome is still limited.…”

Early Epithelial Restitution by Nonsteroidal Anti-Inflammatory Drug–Activated Gene 1 Counteracts Intestinal Ulcerative Injuries

“…Of note, mucosal healing decreases the risk of colorectal cancer in UC. Mucosal healing as an end point in clinical interventions of IBD is also becoming increasingly important in the clinical management (7,8). Therapeutics including biologics currently used in the management of IBD are potentially capable of inducing and maintaining mucosal healing, but the effect size is difficult to assess due to lack of promising predictors quantitatively supporting the endoscopic evaluation.…”