Understanding Remission in IBD

Inflammatory bowel disease (IBD) is a family of chronic bowel diseases caused by inflammation in the body, especially in the intestines. IBD includes Crohn's disease and ulcerative colitis (UC). It is a relapsing disorder, meaning that people living with IBD often experience flares and remission.¹

What is remission?

The treatment goal for IBD is remission. Remission is a period in which you do not have any IBD symptoms. Because IBD is a relapsing disorder, someone who is in remission may come out of remission and then experience a period of acute symptoms called a flare or flare-up.¹

However, the idea of remission has changed over the years. Experts are now learning that IBD inflammation may still be affecting you even if you do not have symptoms.¹

What is mucosal healing?

Inflammation in IBD affects the mucosa, or the lining of the intestines. UC usually affects the colon and rectum. Crohn's can affect any area of the digestive tract from the mouth to the anus.²

Inflammation can affect your gut even if you are not feeling symptoms. That inflammation can lead to long-term health problems, disorders, and future surgeries. Aiming to make the lining of your intestine healthy can prevent many of these complications.¹

To make sure the mucosa is as healthy as possible, doctors focus on "mucosal healing." This begins with looking at the walls of the intestines with a camera to see any damage. These procedures are called endoscopy and colonoscopy. Doctors can also run blood tests to find out if there is inflammation in the body.¹

How does mucosal healing work with Crohn's and UC?

There are several methods doctors may recommend for people with IBD to work toward mucosal healing.

Drug therapy

It makes sense to take IBD drugs when you are experiencing symptoms or a flare. However, your doctor might ask that you continue certain IBD drugs even when you are in remission. This may help you stay in remission.³

The drugs your doctor might want you to keep taking include mesalamine and thiopurines. But other drugs, like corticosteroids, may help stop a flare but should not be taken to stay in remission.³

It is very common for people with IBD to stop taking their medications when in remission. However, keeping up with your prescribed drug therapy can help prevent relapse and more serious complications.³

It is also important to talk to your doctor about other drugs you might be taking. Certain antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs), which include Advil and aspirin, have been shown to cause IBD relapse.³

Gut microbiome

There are multiple factors that combine to cause IBD. UC and Crohn's are mainly autoimmune diseases, which means that the body mistakenly attacks healthy cells. However, people living with IBD also have changes in their gut microbiome.²

Your gut microbiome is the community of bacteria that live in your intestines to help you digest food. It works best when the bacteria are in balance. Some IBD maintenance treatments focus on trying to correct the gut microbiome by restoring this balance.²

Probiotics

Probiotics are pills that contain the same healthy bacteria that live in your gut. Probiotics are thought to help improve gut bacteria balance to improve digestion. Experts also believe they may help heal the mucosa in IBD.⁴

A group of scientists reviewed all the studies looking at probiotics and IBD. They found that probiotics are effective to balance the gut microbiome. They did notice, however, that they seem to work better in people with UC than in people with Crohn's.⁴

Diet

Many people living with IBD know that certain foods seem to trigger or worsen their IBD symptoms. Researchers have looked at how different diets can affect IBD symptoms and mucosal healing. But there is no clear answer for what diet may be best for IBD.²

Diets that seem promising for people with IBD include semi-vegetarian and plant-based diets. It also may help to cut out carrageenan, an additive in many foods.²

To learn more about IBD remission and what you can do to stay in remission, speak to your doctor.