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Achieving Mucosal Healing

Inflammatory bowel disease (IBD) has typically been assessed by the severity of self-reported symptoms. Recently there has been much written about achieving mucosal healing as a better treatment outcome.1 The American College of Gastroenterology updated clinical guidelines to address symptom-based treatment adding mucosal healing as a therapeutic target for ulcerative colitis and Crohn’s disease. Just what mucosal healing means and how to measure it has not yet been fully clarified, leaving some patients and families with questions.

People with IBD may experience symptoms such as chronic diarrhea, weight loss, rectal bleeding, and abdominal pain.2 Many require medications and even surgery to resolve intestinal issues.3 The symptom treatment approach has not been able to alter disease progression. This means it neither reduces the development of long-term complications nor improves long-term patient outcomes.4

What is mucosal healing?

Mucosal healing refers to the repair of the inner lining of the bowel, the absence of tissue ulcers, and inflammation, which are characteristic of an active disease state. Research has demonstrated that managing more than the symptoms, including healing the inner layers of the bowel and intestine, can help people to live longer, healthier lives. IBD in remission, with no signs of microscopic inflammation, may mean fewer flare-ups and invasive treatments, avoiding surgery, hospitalization or relapse.2,5

By examining the lining of the digestive tract visible during an endoscopy, along with tissue samples evaluated by pathologists, your doctors can evaluate how the mucosa are responding to treatment.1,2 If there is evidence of microscopic inflammation in biopsy samples, it indicates that the mucosal involvement is not completely resolved. This means that there is a higher risk of relapse.2

Treatment response and the rate of healing differs by individual.5,6 Yet it is clear that sustained remission leads to a better quality of life than just treating symptoms as they develop. Mucosal healing can also lead to the reduction of other medical and psychological risk factors including the possibility of developing colon cancer. Mucosal healing is an achievable therapeutic goal.

Talk to your doctor about these new protocols

During an office visit, physicians traditionally talk to their patients about medications and symptoms like bleeding, diarrhea, and pain.2 Yet the new treatment protocols raise a topic to be discussed at your visit: objective assessment of disease activity.2 Findings from clinical trials suggest using technology, like endoscopy, to assess damage to the mucosal layer of the digestive tract will help your health care team assess any ongoing damage to the mucosal layer of the digestive tract.

Talk to your doctor about medication options and a regular schedule for endoscopic evaluation. Although no one wants unnecessary procedures or to have more doctor visits, this process may help patients achieve a greater level of healing. Endoscopic or radiologic evaluations are more objective than symptom-reporting evaluations. This may drive medication decisions, requiring them to be adjusted more frequently, combined to improve response, or to address comorbidities and drug-related risks.4,5 This process can be more frequent during the treatment phases and on a periodic basis after achieving mucosal healing.4

Questions for the doctor about mucosal healing:

  1. Is IBD causing my symptoms or could it be something else?
  2. What specific areas of my intestine are inflamed?
  3. What medications are right for me? How soon can I expect relief?
  4. Are there other treatment options?
  5. What should I do if the symptoms return?
  6. When should I schedule my next appointment?
  7. How often do I need an endoscopy or colonoscopy or any other follow up care?
  8. Do I need to change anything about my lifestyle, e.g., diet vitamins, exercise?
  9. What tests do I need and how often?
  1. Reyes A. Achieving Mucosal Healing in Crohn's Disease and Ulcerative Colitis. Rheumatology Network. Available at: https://www.rheumatologynetwork.com/inflammatory-bowel-disease/achieving-mucosal-healing-crohns-disease-and-ulcerative-colitis/ Accessed 9/27/19.
  2. A Closer Look at Mucosal Healing in Ulcerative Colitis. Available at: https://www.celgene.com/mucosal-healing/. Accessed 9/28/19.
  3. Neurath MF. New targets for mucosal healing and therapy in inflammatory bowel diseases. Mucosal Immunology. 2013;7(1):6-19. doi:10.1038/mi.2013.73.
  4. Mucosal healing in inflammatory bowel disease. Mayo Clinic. Available at: https://www.mayoclinic.org/medical-professionals/digestive-diseases/news/mucosal-healing-in-inflammatory-bowel-disease/mac-20430502. Accessed 9/28/19.
  5. Tresca A. What Is Mucosal Healing in IBD? Verywell Health. Available at: https://www.verywellhealth.com/mucosal-healing-in-ibd-4427792. Accessed 9/27/19.
  6. Miheller P. Mandel M. et al. Clinical Aspects of Mucosal Healing in Inflammatory Bowel Diseases. Medscape. Available at: https://www.medscape.com/viewarticle/811950_4. Accessed 9/28/19.

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