Mucosal healing and deep remission: What does it mean?

Table 1 Association between the definitions of remission and mucosal healing and actual healing rates in patients with ulcerative colitis treated with mesalazine

Author	Design	Study	Timing of endoscopy	Endoscopic index	Def. of MH	No of pat. Achieving MH
Vecchi (2001)	Mc, RCT	Mesalazine 4 g orally vs 2 + 2 g orally and enema	6 wk	Rachmilewitz	Rachmilewitz < 4	58% vs 71%
Malchow (2002)	Mc, db, RCT	Mesalazine 4 g enema vs 1 g foam	4 wk	Rachmilewitz	Rachmilewitz < 2	38% vs 37%
Mansfield (2002)	Mc, db, RCT	Balsalazide 6.75 g vs sulfasal. 3g	8 wk	4 point scale	Score of 0 = normal mucosa	27% vs 25%
Hanauer (2007) Ascend	Mc, db, RCT	Asacol 4.8 g vs 2.4 g	6 wk	Descriptive, no score	Normal endoscopic finding	25% vs 20%
Kamm (2007) MMX	Mc, db, RCT	MMX mes. 4.8 g vs 2.4 g vs placebo	8 wk	Mod. Sutherland index	Mod Sutherland index < 1	77% vs 69% vs 46%
Kruis (2009)	Mc, db, RCT	Mesalazine 3 g vs 1g x 3	8 wk	Rachmilewitz	Rachmilewitz < 4	71% vs 70%

Mc: Multicenter; db: Double-blind; RCT: Randomized controlled trial; MH: Mesalazine.

Table 2 One of the problems in endoscopic ulcerative colitis scores is the application of varying criteria

	Truelove	Baron	Powell-T (St Mark’s)	Levine	Rach-milewitz	Modified Baron	Mayo	Sutherland
Erythema						+	+
Edema				+
Granularity				+	+	+
Vascular pattern		+		+	+	+	+
Friability	+	+	+	+	+	+	+	+
Erosions				+	+		+
Ulceration				+	+	+	+
Exudate					+			+
Remission	0	0-1			0-2	0-1	0-1	0

Table 3 Proposal of the CBEHI classification to assess Crohn’s disease activity

Activity level	Definition	Code
Clinical activity	Remission: CDAI < 150	C0
	Active: CDAI ≥ 150	C1
Biochemical activity	CRP normal	B0 (CRP)
	Elevated CRP	B1 (CRP)
	Calprotectin < 200 μg/g	B0 (Calpro)
	Calprotectin ≥ 200 μg/g	B1 (Calpro)
Endoscopic activity	Remission: SES-CD < 4	E0
	Active: SES-CD ≥ 4	E1
Histologic activity	Inactive	H0
	Active	H1
Imaging	Inactive: no fistulas, no stenoses	I0
	Active: presence of either fistula and/or stenosis	I1

Example: A Crohn’s disease (CD) patient with C0B0 (CRP) E1H1I0 would have clinical and biochemical remission, but endoscopic and histologic activity.