Neurath Markus F, Vieth Michael
Medical Clinic 1 & Deutsches Zentrum Immuntherapie DZI, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
Pathology Clinic, Klinikum Bayreuth GmbH, Friedrich-Alexander-Universität Erlangen-Nürnberg, Bayreuth, Germany.
Gut. 2023 Nov;72(11):2164-2183. doi: 10.1136/gutjnl-2023-329964. Epub 2023 Aug 27.
on endoscopy has emerged as a key prognostic parameter in the management of patients with IBD (Crohn's disease, ulcerative colitis/UC) and can predict sustained clinical remission and resection-free survival. The structural basis for this type of mucosal healing is a progressive resolution of intestinal inflammation with associated healing of ulcers and improved epithelial barrier function. However, in some cases with mucosal healing on endoscopy, evidence of histological activity in mucosal biopsies has been observed. Subsequently, in UC, a second, deeper type of mucosal healing, denoted histological healing, was defined which requires the absence of active inflammation in mucosal biopsies. Both levels of mucosal healing should be considered as initial events in the resolution of gut inflammation in IBD rather than as indicators of complete transmural healing. In this review, the effects of anti-inflammatory, biological or immunosuppressive agents as well as small molecules on mucosal healing in clinical studies are highlighted. In addition, we focus on the implications of mucosal healing for clinical management of patients with IBD. Moreover, emerging techniques for the analysis of mucosal healing as well as potentially deeper levels of mucosal healing such as transmural healing and functional barrier healing of the mucosa are discussed. Although none of these new levels of healing indicate a definitive cure of the diseases, they make an important contribution to the assessment of patients' prognosis. The ultimate level of healing in IBD would be a resolution of all aspects of intestinal and extraintestinal inflammation (complete healing).
内镜检查结果已成为炎症性肠病（克罗恩病、溃疡性结肠炎/UC）患者管理中的关键预后参数，可预测持续临床缓解和无切除生存率。这种黏膜愈合的结构基础是肠道炎症的逐步消退，伴有溃疡愈合和上皮屏障功能改善。然而，在一些内镜检查显示黏膜愈合的病例中，已观察到黏膜活检有组织学活动的证据。随后，在溃疡性结肠炎中，定义了第二种更深层次的黏膜愈合，即组织学愈合，这要求黏膜活检中无活动性炎症。这两种黏膜愈合水平都应被视为炎症性肠病肠道炎症消退的初始事件，而非全层愈合的指标。在本综述中，重点介绍了抗炎药、生物制剂或免疫抑制剂以及小分子在临床研究中对黏膜愈合的影响。此外，我们关注黏膜愈合对炎症性肠病患者临床管理的意义。此外，还讨论了分析黏膜愈合的新兴技术以及可能更深层次的黏膜愈合，如全层愈合和黏膜功能屏障愈合。尽管这些新的愈合水平均未表明疾病得到彻底治愈，但它们对评估患者预后具有重要意义。炎症性肠病的最终愈合水平将是肠道和肠外炎症各方面的消退（完全愈合）。
