INSERM U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Université Henri Poincaré 1, Vandoeuvre-lès-Nancy, France.
J Crohns Colitis. 2011 Oct;5(5):477-83. doi: 10.1016/j.crohns.2011.06.009. Epub 2011 Aug 3.
Over the past years, mucosal healing has emerged as a major therapeutic goal in clinical trials in inflammatory bowel diseases. Accumulating evidence indicates that mucosal healing may change the natural course of the disease by decreasing the need for surgery and reducing hospitalization rates in both ulcerative colitis and Crohn's disease. Mucosal healing may also prevent the development of long-term disease complications, such as bowel damage in Crohn's disease and colorectal cancer in ulcerative colitis. Histologic healing may be the ultimate therapeutic goal in ulcerative colitis, whereas its impact on the course of Crohn's disease is unknown. Complete mucosal healing may be required before considering drug withdrawal. Targeting early Crohn's disease is more effective than approaches aimed at healing mucosa in longstanding disease. Several questions remain to be answered: should mucosal healing be systematically used in clinical practice? Should we optimize therapies to achieve mucosal healing? What is the degree of intestinal healing that is required to change the disease course? Large prospective studies addressing these issues are needed.
在过去的几年中，黏膜愈合已成为炎症性肠病临床试验中的主要治疗目标。越来越多的证据表明，黏膜愈合可以通过减少手术需求和降低溃疡性结肠炎和克罗恩病的住院率来改变疾病的自然进程。黏膜愈合也可能预防长期疾病并发症的发生，如克罗恩病的肠道损伤和溃疡性结肠炎的结直肠癌。组织学愈合可能是溃疡性结肠炎的最终治疗目标，而其对克罗恩病病程的影响尚不清楚。在考虑停药之前，可能需要完全的黏膜愈合。在慢性疾病中，黏膜愈合的靶向治疗比针对黏膜愈合的治疗方法更有效。仍有一些问题有待回答：黏膜愈合是否应系统地用于临床实践？我们是否应优化治疗以实现黏膜愈合？需要达到何种程度的肠道愈合才能改变疾病进程？需要进行大型前瞻性研究来解决这些问题。
