Did you know there are multiple types of remission in IBD?
Clinical remission
This is the lowest level of remission where you are symptom free but may still have inflammation.
Since symptoms can be poorly correlated with disease activity, you should always keep getting your inflammation checked regardless of whether or not you are experiencing symptoms.
If you are in clinical remission but still have inflammation, you are at a higher risk of long-term disease complications including flares and surgeries.1-2
Biochemical remission
This level of remission means that your inflammatory stool tests (fecal calprotectin) and blood tests (c-reactive protein or CRP, and erythrocyte sedimentation rate or ESR) are within normal limits.
Surgical remission
When you’re in remission because your doctor removed the inflamed part or parts of your bowel.
Endoscopic remission
This level of remission means that your doctor didn’t see any visible signs of active inflammation during a colonoscopy, sigmoidoscopy, or endoscopy.
If you’re in endoscopic remission, there may still be microscopic inflammation not visible to the eye.
This level of remission is associated with improved outcomes, including long-term (≥50 weeks) clinical remission in Crohn's disease and ulcerative colitis, lower need for steroids in ulcerative colitis, and reduced need for surgery/hospitalizations in both Crohn’s disease and ulcerative colitis.1-2
Histological remission
You’re in histological remission when the doctor takes biopsies during your colonoscopy, sigmoidoscopy, or endoscopy and those biopsies don’t show any active inflammation under the microscope.Â
Deep remission
Although there is no standardized definition of the term deep remission, this term is often used to describe a combination of clinical, endoscopic, and/or histologic assessments.3
More research is needed to determine whether or not this level of remission provides any benefits over endoscopic remission.4
Being in deep remission also doesn’t mean that you’re cured of your Crohn’s or colitis, so it’s important to continue working with your medical team to reduce the risk of active disease in the future.
Intestinal barrier healing / functional remission
This is a new level of remission that is beginning to be analyzed using confocal laser endomicroscopy to determine the integrity of the intestinal barrier.
A recent study involving 181 patients (100 with Crohn’s disease and 81 with ulcerative colitis) found that barrier healing was superior to both endoscopic and histologic remission for predicting disease outcomes including flares, hospitalizations, and surgeries.5
More research is needed to determine the implications of deep remission and intestinal barrier healing on long-term outcomes for IBD patients.
References
- Shah SC, Colombel JF, Sands BE, Narula N. Mucosal Healing Is Associated With Improved Long-term Outcomes of Patients With Ulcerative Colitis: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2016 Sep;14(9):1245-1255.e8. doi: 10.1016/j.cgh.2016.01.015. Epub 2016 Jan 30. PMID: 26829025.
- Shah SC, Colombel JF, Sands BE, Narula N. Systematic review with meta-analysis: mucosal healing is associated with improved long-term outcomes in Crohn's disease. Aliment Pharmacol Ther. 2016 Feb;43(3):317-33. doi: 10.1111/apt.13475. Epub 2015 Nov 25. PMID: 26607562.
- Rogler G, Vavricka S, Schoepfer A, Lakatos PL. Mucosal healing and deep remission: what does it mean? World J Gastroenterol. 2013 Nov 21;19(43):7552-60. doi: 10.3748/wjg.v19.i43.7552. PMID: 24282345; PMCID: PMC3837253.
- Turner D, Ricciuto A, Lewis A, D'Amico F, Dhaliwal J, Griffiths AM, Bettenworth D, Sandborn WJ, Sands BE, Reinisch W, Schölmerich J, Bemelman W, Danese S, Mary JY, Rubin D, Colombel JF, Peyrin-Biroulet L, Dotan I, Abreu MT, Dignass A; International Organization for the Study of IBD. STRIDE-II: An Update on the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) Initiative of the International Organization for the Study of IBD (IOIBD): Determining Therapeutic Goals for Treat-to-Target strategies in IBD. Gastroenterology. 2021 Apr;160(5):1570-1583. doi: 10.1053/j.gastro.2020.12.031. Epub 2021 Feb 19. PMID: 33359090.
- Rath T, Atreya R, Bodenschatz J, Uter W, Geppert CE, Vitali F, Fischer S, Waldner MJ, Colombel JF, Hartmann A, Neurath MF. Intestinal Barrier Healing Is Superior to Endoscopic and Histologic Remission for Predicting Major Adverse Outcomes in Inflammatory Bowel Disease: The Prospective ERIca Trial. Gastroenterology. 2023 Feb;164(2):241-255. doi: 10.1053/j.gastro.2022.10.014. Epub 2022 Oct 21. PMID: 36279923.
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