Mucosal healing and anti TNFs in IBD.

Mucosal healing has been incorporated in the assessment of treatment efficacy in ulcerative colitis, but in Crohn's disease this concept has only emerged after biological therapies have been evaluated in clinical trials. Systemic steroids don't 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. For infliximab mucosal healing is associated with a reduction in hospitalizations and surgeries. On the contrary, the benefit of treating 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 and when treatment discontinuation is being considered.