Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK.
Aliment Pharmacol Ther. 2011 Jul;34(2):113-24. doi: 10.1111/j.1365-2036.2011.04701.x. Epub 2011 May 25.
There is no international agreement on scoring systems used to measure disease activity in ulcerative colitis, nor is there a validated definition for disease remission.
To review the principles and components for defining remission in ulcerative colitis and propose a definition that will help improve patient outcomes.
A review of current standards of remission from the perspective of clinical trials, guidelines, clinical practice and patients was conducted by the authors. Selected literature focused on the components of a definition of remission, the utility of a definition and treatment strategies, based on current definitions.
Different definitions of remission affect the assessment of outcome and make it difficult to compare trials. In the clinic, endoscopy is rarely used to confirm remission, because mucosal healing has only recently begun to be related to the duration of subsequent remission in a way that will affect clinical practice. Histopathology may be the ultimate arbiter of mucosal healing. There is no agreement on the definition of remission in current guidelines. Patient-defined remission may predict endoscopic remission, but has yet to be shown to predict duration of remission.
A standard based on clinical symptoms and endoscopy is proposed. Histopathology is a third dimension of remission that may have prognostic value. The definition of remission should help predict long-term outcome. The expectations of patients and their physicians need to be raised, as the goal of treatment of active ulcerative colitis should be to induce remission.
目前尚无用于衡量溃疡性结肠炎疾病活动度的评分系统的国际共识，也没有针对疾病缓解的验证定义。
回顾溃疡性结肠炎缓解定义的原则和组成部分，并提出有助于改善患者结局的定义。
作者从临床试验、指南、临床实践和患者的角度对缓解的现有标准进行了综述。根据现有定义，选择的文献重点关注缓解定义的组成部分、定义的实用性和治疗策略。
不同的缓解定义会影响对结局的评估，且使试验之间难以进行比较。在临床上，内镜检查很少用于确认缓解，因为黏膜愈合最近才开始与随后缓解的持续时间相关，从而影响临床实践。组织病理学可能是黏膜愈合的最终仲裁者。目前的指南中没有关于缓解的定义达成共识。患者定义的缓解可能预测内镜缓解，但尚未证明能预测缓解的持续时间。
提出了一种基于临床症状和内镜的标准。组织病理学是缓解的第三个维度，可能具有预后价值。缓解的定义应有助于预测长期结局。需要提高患者及其医生的期望，因为治疗活动性溃疡性结肠炎的目标应该是诱导缓解。
