Mucosal healing in ulcerative colitis: what does it mean?

Mucosal healing has emerged as an important therapeutic endpoint in both clinical trials and clinical practice. It predicts:1.less corticosteroid use 2. lower hospitalization rates 3. increased sustained clinical remission4. lower colectomy rates.5. decrease in the risk of colorectal cancer complicating ulcerative colitis.Mucosal healing should consequently be recognised by clinicians and healthcare providers as a goal for IBD therapy, but there needs to be a common language for describing disease activity. An International Organization of IBD (IOIBD) task force defined mucosal healing in ulcerative colitis as the absence of friability, blood, erosions, and ulcers in all visualized segments of the colonic mucosa. Nevertheless, some studies allow erythema and friability in the assessment of mucosal healing and there is no validated definition, which creates problems comparing trials. Limitations of mucosal healing Endoscopic procedures are invasive. Even validated indices such as the UCEIS need further research to determine what degree of improvement is clinically meaningful. Although disease may appear inactive at endoscopy, microscopic disease activity may persist, which is associated with a shorter time to relapse , so endoscopic mucosal healing alone may yet turn out to be an insufficient therapeutic goal. Surrogate, non-invasive markers of mucosal healing are needed, but biomarkers such as fecal calprotectin have yet to demonstrate sufficient specificity for mucosal healing to replace endoscopic assessment.