Remission – a decrease or disappearance of the symptoms of inflammatory bowel disease (IBD) – is the goal for those living with either Crohn’s disease or ulcerative colitis. Remission holds a variety of meanings for people living with IBD.
In our 2017 IBD in America survey, 72% of those taking the survey said they’ve experienced remission at some point in their IBD journey, and respondents equated remission to feelings of freedom, happiness, comfort, energy, heaven, and peace, as well as noting how remission would let them feel like they have a “normal life.”
However, experts believe that clinical remission, defined as symptom control, isn’t enough. Due to the chronic, progressive, and destructive nature of IBD, treatment may be needed even if a person isn’t experiencing symptoms.
Why is treatment necessary when symptoms aren’t present?
Even during periods of time when a person with IBD isn’t having symptoms and is considered in remission, laboratory or imaging tests can show evidence of persistent inflammation. The persistent inflammation that is characteristic of IBD is believed to lead to the progressive damage to the bowel over time, leading to complications such as strictures, fistulae, and abscesses. These complications often require surgical resection of the intestines, in which the diseased portion of the intestines is removed and the healthy ends are reconnected. Surgery can be effective but can lead to disability.
Long-term studies of people with Crohn’s disease have demonstrated the progressive nature of the condition. In one study, more than 2000 patients were followed at a single treatment center. Sixty percent of the patients developed a penetrating or stricturing complication, and five years after diagnosis, only half the patients hadn’t experienced a complication. By twenty years after diagnosis, only one tenth of the patients hadn’t had a complication.
Another study that followed people with Crohn’s disease over twenty years found that the risk of developing a penetrating or stricturing complication increased over time:
At diagnosis, 80% had uncomplicated inflammatory disease
After 90 days, the risk of developing a complication was 19%
After 1 year, the risk of developing a complication was 22%
After 5 years, the risk of developing a complication was 34%
After 20 years, the risk increased to 51%
Because of the damage and disability the chronic inflammation of IBD can cause, it’s important to treat beyond the symptoms.
In the IBD in America survey, 33% of respondents who were once in remission admitted they no longer were, and approximately three-fourths of them experienced remission for less than 3 years. However, even those currently in remission (40% of respondents) said they take steps to stay in remission, including continuing to use prescription medications (77%), avoiding certain foods (74%), and seeing their doctor regularly (63%).
Types of remission
Researchers have defined several classifications of remission that are important for people with IBD, including:
Clinical remission – symptom control, or the cessation of symptoms
Endoscopic remission – the healing of the mucosal membranes in the lining of the intestines
Normalization of serum (blood) and fecal markers of inflammation
While the absence of symptoms is an important goal in the early stages of the disease, doctors believe that equally important goals for IBD are no disease progression, no complications or disability, and a normal quality of life. In later stages of IBD, goals shift to stabilization of symptoms, no progression of damage or disability, and improved quality of life.
Panaccione R, et al. Evolving definitions of remission in Crohn’s disease. Inflamm Bowel Dis. 2013;19:1645-1653.