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Mucosal Healing in Ulcerative Colitis: A Comprehensive Review

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Abstract

Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by periods of remission and periods of relapse. Patients often present with symptoms such as rectal bleeding, diarrhea and weight loss, and may require hospitalization and even colectomy. Long-term complications of UC include decreased quality of life and productivity and an increased risk of colorectal cancer. Mucosal healing (MH) has gained progressive importance in the management of UC patients. In this article, we review the endoscopic findings that define both mucosal injury and MH, and the strengths and limitations of the scoring systems currently available in clinical practice. The basic mechanisms behind colonic injury and MH are covered, highlighting the pathways through which different drugs exert their effect towards reducing inflammation and promoting epithelial repair. A comprehensive review of the evidence for approved drugs for UC to achieve and maintain MH is provided, including a section on the pharmacokinetics of anti-tumor necrosis factor (TNF)-α drugs. Currently approved drugs with proven efficacy in achieving MH in UC include salicylates, corticosteroids (induction only), calcineurin inhibitors (induction only), thiopurines, vedolizumab and anti-TNFα drugs (infliximab, adalimumab, and golimumab). MH is of crucial relevance in the outcomes of UC, resulting in lower incidences of clinical relapse, the need for hospitalization and surgery, as well as reduced rates of dysplasia and colorectal cancer. Finally, we present recent evidence towards the need for a more strict definition of complete MH as the preferred endpoint for UC patients, using a combination of both endoscopic and histological findings.

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  1. Hospital da Senhora da Oliveira–Guimarães, Rua dos Cutileiros, Creixomil, 4831-044, Guimarães, Portugal

    Pedro Boal Carvalho & José Cotter

  2. Life and Health Sciences Research Institute (ICVS), University of Minho, Campus Gualtar, 4710-057, Braga, Portugal

    José Cotter

  3. ICVS/3B’s, PT Government Associate Laboratory, 4710-057, Guimarães/Braga, Portugal

    José Cotter

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  1. Pedro Boal Carvalho
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  2. José Cotter
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Correspondence to Pedro Boal Carvalho.

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Dr. Boal Carvalho and Prof. Cotter report no conflicts of interest relating to the content of this review.

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No funding was received for the preparation of this article.

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Boal Carvalho, P., Cotter, J. Mucosal Healing in Ulcerative Colitis: A Comprehensive Review. Drugs 77, 159–173 (2017). https://doi.org/10.1007/s40265-016-0676-y

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  • DOI: https://doi.org/10.1007/s40265-016-0676-y

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