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Different levels of healing in inflammatory bowel diseases: mucosal, histological, transmural, barrier and complete healing
  1. Markus F Neurath1,
  2. Michael Vieth2
  1. 1 Medical Clinic 1 & Deutsches Zentrum Immuntherapie DZI, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
  2. 2 Pathology Clinic, Klinikum Bayreuth GmbH, Friedrich-Alexander-Universität Erlangen-Nürnberg, Bayreuth, Germany
  1. Correspondence to Professor Markus F Neurath, First Department of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, D-91054, Germany; markus.neurath{at}


Mucosal healing 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).

  • endoscopy
  • mucosal barrier
  • Crohn's disease
  • ulcerative colitis

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  • Contributors MFN wrote the draft of the paper, designed figures and performed literature searches. MV provided histological images, discussed findings and wrote parts of the manuscript.

  • Funding The research of MFN has been supported by the DFG SFB1181 and TRR241.

  • Competing interests MFN served as an advisor to Pentax, PPM, Janssen, Takeda, AbbVie, Boehringer and Pfizer.

  • Provenance and peer review Commissioned; externally peer reviewed.