Medical Therapy and Mucosal Healing

In ulcerative colitis, mucosal healing has clearly been incorporated in the assessment of treatment efficacy. In Crohn's disease, this concept has only emerged in recent clinical trials with biological therapies. Systemic steroids don't reliably induce mucosal healing in Crohn's disease, but purine analogues and anti-TNF agents have a potential to heal mucosal ulcerations. Evidence for mucosal healing has now been provided for the anti-TNF agents infliximab, adalimumab and certolizumab pegol. For infliximab in Crohn's disease, mucosal healing has been associated with a reduction in clinical relapses, disease-related hospitalizations and surgeries. On the contrary, the benefit of treating asymptomatic patients with IBD more intensively until they achieve mucosal healing has not been proven. In clinical practice, assessing mucosal healing should be considered in patients with persistent symptoms despite adequate therapy as well as in patients where treatment discontinuation is being considered.