Mucosal Healing in Crohn's Disease: Bull's Eye or Bust? The "Relative" Con Position.
Crohn's disease
Mucosal healing
Partial healing
Treatment
Journal
Inflammatory intestinal diseases
ISSN: 2296-9365
Titre abrégé: Inflamm Intest Dis
Pays: Switzerland
ID NLM: 101677990
Informations de publication
Date de publication:
Jan 2022
Jan 2022
Historique:
received:
13
09
2021
accepted:
15
09
2021
entrez:
28
2
2022
pubmed:
1
3
2022
medline:
1
3
2022
Statut:
epublish
Résumé
Crohn's disease is a progressive inflammatory bowel disease. Persistent untreated inflammation can cumulatively result in bowel damage in the form of strictures, fistulas, and fibrosis, which can ultimately result in the need for major abdominal surgery. Mucosal healing has emerged as an attractive, yet ambitious goal in the hope of preventing long-term complications. Clinical remission is an inadequate measure of disease activity. Noninvasive markers such as fecal calprotectin, CRP, or small bowel ultrasound are useful adjunct tools. However, endoscopic assessment remains the cornerstone in building a treatment plan. Achieving complete mucosal healing has proved to be an elusive goal even in the ideal setting of a clinical trial. Aiming for complete mucosal healing in all patients may result in overuse of medications, higher costs, and potential side effects of aggressive immunosuppressive treatment. More practical goals such as relative or partial healing, for example, 50% improvement in inflammation and reduction in size of ulcers, ought to be considered, particularly in difficult-to-treat populations.
Sections du résumé
BACKGROUND
BACKGROUND
Crohn's disease is a progressive inflammatory bowel disease. Persistent untreated inflammation can cumulatively result in bowel damage in the form of strictures, fistulas, and fibrosis, which can ultimately result in the need for major abdominal surgery. Mucosal healing has emerged as an attractive, yet ambitious goal in the hope of preventing long-term complications.
SUMMARY
CONCLUSIONS
Clinical remission is an inadequate measure of disease activity. Noninvasive markers such as fecal calprotectin, CRP, or small bowel ultrasound are useful adjunct tools. However, endoscopic assessment remains the cornerstone in building a treatment plan. Achieving complete mucosal healing has proved to be an elusive goal even in the ideal setting of a clinical trial.
KEY MESSAGES
CONCLUSIONS
Aiming for complete mucosal healing in all patients may result in overuse of medications, higher costs, and potential side effects of aggressive immunosuppressive treatment. More practical goals such as relative or partial healing, for example, 50% improvement in inflammation and reduction in size of ulcers, ought to be considered, particularly in difficult-to-treat populations.
Identifiants
pubmed: 35224017
doi: 10.1159/000519731
pii: iid-0007-0042
pmc: PMC8820152
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
42-49Informations de copyright
Copyright © 2021 by S. Karger AG, Basel.
Déclaration de conflit d'intérêts
The authors have no conflicts of interest to declare.
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