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World J Gastrointest Pathophysiol. May 15, 2014; 5(2): 54-62
Published online May 15, 2014. doi: 10.4291/wjgp.v5.i2.54
“Mucosal healing” in ulcerative colitis: Between clinical evidence and market suggestion
Cristiano Pagnini, Francesca Menasci, Stefano Festa, Gianenrico Rizzatti, Gianfranco Delle Fave
Cristiano Pagnini, Francesca Menasci, Stefano Festa, Gianenrico Rizzatti, Gianfranco Delle Fave, “Sapienza” University of Rome, Faculty of Medicine and Psychology, S. Andrea Hospital, 00189 Rome, Italy
Cristiano Pagnini, Research Center, S.Pietro Hospital, 00189 Rome, Italy
Author contributions: Pagnini C designed and wrote the paper; Menasci F, Festa S and Rizzatti G wrote the paper; Delle Fave G edited the paper.
Correspondence to: Cristiano Pagnini, MD, PhD, “Sapienza” University of Rome, Faculty of Medicine and Psychology, S. Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy. cristiano.pagnini@uniroma1.it
Telephone: +39-06-33779 Fax: +39-06-33776601
Received: January 16, 2014
Revised: April 4, 2014
Accepted: April 16, 2014
Published online: May 15, 2014
Processing time: 124 Days and 9.6 Hours
Abstract

In recent decades, the prominent role of endoscopy in the management of ulcerative colitis (UC) has been translated into the concept of mucosal healing (MH) as a fundamental therapeutic end-point. This is partially the consequence of growing evidence of a positive prognostic role of MH on the disease course and partially due to market cues indicating a higher rate of MH in patients treated by novel potent biologic agents. The aim of the present review is to clarify the current knowledge of MH in UC, analyzing the definition, the putative prognostic role and the association of MH with the current drugs used to treat UC patients. Because solid data about the management of UC patients based solely on the healing of the mucosa are not yet available, a tailored approach for individual patients thatconsiders the natural history of UC and the presence of prognostic indicators of aggressive disease is desirable. Consequently, unnecessary examinations and treatment would be avoided and restricted to UC patients who require the maximum amount of effort to affect the disease course in the short and long term.

Keywords: Ulcerative colitis; Mucosal healing; Prognosis; Evidence

Core tip: In recent years, the concept that the management of ulcerative colitis patients should aim to heal the mucosa rather than resolve symptoms has been decisively proposed. Herein, we review the current evidence supporting this statement and analyze the possible practical implications in the current management of ulcerative colitis patients.