Clinical implications of mucosal healing in the management of patients with inflammatory bowel disease.

The natural history of Crohn's Disease and ulcerative colitis is characterized by repeated episodes of inflammation and ulceration of the bowel. This results in complications implying a worse quality of life and significant healthcare costs, due to hospitalization, surgery and an escalation of therapy. The main goal of the therapy in inflammatory bowel disease is to achieve and maintain disease remission, with an improved health-related quality of life, less hospitalization, and less surgery. The concept of remission has changed in the recent years. In fact the concept of clinical remission, where only the patients' symptoms are in remission, has been replaced by the new concept of deep remission. This implies not only sustained clinical remission but also complete mucosal healing, with the normalization of serological activity indexes. Mucosal healing, rarely achieved with traditional drugs, can now be achieved and maintained by means of biological drugs. Current evidence suggests that the achievement of mucosal healing might significantly change the natural course of inflammatory bowel diseases and should represent an objective end point of future therapeutic trials, particularly for colonic diseases.