Mucosal Healing: An Objective Measure of Disease Activity?

The absence of inflammatory and ulcerative lesions in all segments of the colon, also known as mucosal healing, should be the end goal in treating patients with ulcerative colitis according to an editorial in the journal Gastrointestinal Endoscopy.

The authors believe the analysis in the study by Flores and colleagues, Impact of Mucosal Inflammation on Risk of Colorectal Neoplasia in Patients with Ulcerative Colitis: A Systematic Review and Meta-Analysis, reaffirms the suspicion that ongoing colonic inflammation not only increases the risk of abnormal growth of colorectal tissue (pre-cancer and/or cancer), but also may affect guidelines for surveillance colonoscopies.

“There are several reasons to target mucosal healing in patients with ulcerative colitis, reducing cancer risk being one of them. If we are truly aiming for mucosal healing, this may mean more aggressive medical therapy early in the treatment course even if histologic activity is not necessarily reflected in patients’ symptoms,” explained corresponding author Francis A. Farraye, MD, MSc, professor of medicine at BUSM.

The authors said the pivotal role played by mucosal healing in driving favorable outcomes in ulcerative colitis is acknowledged, but whether this bar should unequivocally be set at histologic healing and if so, at what level, remains to be established. “Arguably, the first step is to better define histologic remission and healing In addition, the use of validated endoscopic scoring systems that provide objectivity, uniformity and standardization in reporting mucosal appearances, augmenting clinical decision making and ultimately affecting appropriate treatment targets and desirable patient outcomes,” said Farraye, clinical director in the section of gastroenterology at Boston Medical Center.