From the Guidelines
Remission in Ulcerative Colitis (UC) is typically defined as a state where patients experience symptomatic remission, characterized by normal stool frequency and no blood in the stool, as well as endoscopic healing, defined as normal mucosa or chronic changes without friability.
Key Components of Remission
- Symptomatic remission: defined as normal stool frequency (≤3 stools per day) and no rectal bleeding 1
- Endoscopic healing: defined as normal mucosa, vascular blurring, or chronic changes (e.g., inflammatory polyps, scarring) without friability 1
- Histological remission: although not always included in the definition of remission, it is considered a more rigorous and desirable outcome, characterized by the absence of basal plasmacytosis or neutrophilia in rectal biopsies 1
Comprehensive Disease Control
In recent years, there has been a shift towards a more patient-centric approach, considering a broader definition of comprehensive disease control that includes aspects such as:
- Disease-related quality of life
- Inflammatory biomarkers (e.g., faecal calprotectin, C-reactive protein)
- Patient-reported symptoms (e.g., bowel urgency, abdominal pain, extraintestinal manifestations, fatigue, sleep disturbance) 1 This approach recognizes that remission is not just the absence of symptoms, but also the presence of a good quality of life and the absence of inflammation.
Treatment Targets
The STRIDE II initiative recommends evaluating stool frequency and rectal bleeding as short-term targets, normalization of inflammatory biomarkers as intermediate treatment targets, and normalization of quality of life and endoscopic remission as long-term treatment targets 1.
Clinical Practice
In clinical practice, the definition of remission may vary, but it is generally considered to be a state where patients experience symptomatic remission and endoscopic healing, with the goal of achieving comprehensive disease control and improving patient outcomes 1.
From the Research
Definition of Remission in Ulcerative Colitis (UC)
- Remission in UC is defined by a composite of patient-reported outcomes and Mayo endoscopy subscore (MES) 0 or 1, which is a recommended treatment target in patients with UC 2.
- Clinical remission is associated with a lower risk of relapse, and achieving more rigorous treatment endpoints such as endoscopic and histologic remission can substantially reduce the risk of clinical relapse 2, 3.
Types of Remission in UC
- Clinical remission: defined by a composite of patient-reported outcomes and MES 0 or 1 2.
- Endoscopic remission: defined by MES 0, which is associated with a lower risk of clinical relapse compared to MES 1 2.
- Histologic remission: defined by the absence of histologic disease activity, which is associated with a lower risk of clinical relapse compared to persistent histologic activity 2, 3.
- Deep remission: a concept that goes beyond clinical symptoms and includes biomarker remission and mucosal healing, which may be defined as clinical and endoscopic remission in UC 4.
Importance of Remission in UC
- Achieving remission is a key treatment goal in UC, as it is associated with improved outcomes and reduced risk of disease progression 5, 6.
- Remission rates for UC remain low despite significant progress in disease understanding and treatment options, highlighting the need for continued development of novel therapeutic agents and personalized treatment approaches 6.