In the absence of direct evidence of cancer benefit, the movement of research in IBD toward control of mucosal inflammation as a disease-modifying end point seems sufficient to continue to pursue improved disease control and, secondarily, to anticipate reduced neoplasia as a downstream result. Medical therapy, as in the case of 5-ASA, may have mechanistic plausibility for direct antineoplastic properties, but others, such as thiopurines, do not, suggesting that there is a primary chemopreventive benefit derived from the ability to achieve endoscopic and histologic healing. Mucosal healing induced by medical therapy may also provide a secondary preventive

benefit by allowing improved endoscopic

selleck chemicals llc and histologic detection and differentiation between reactive epithelial changes and dysplasia. Of the many risk factors for the development of colitis-associated CRC, the only modifiable one for a treating physician is the presence and severity of chronic inflammation. Over the past 20 years, significant progress has been made with the use of agents capable of mucosal healing, and during this time the risk of CRC in IBD patients has declined. Although the mechanism of the declining risk of CRC in IBD remains unclear, the likely determinants are a combination of primary prevention from improved medical therapies able this website to induce mucosal healing, and secondary prevention from improved surveillance endoscopy technologies. “
“Mucosal healing is an important end point in clinical trials. UC and Crohn’s disease are characterized by the presence of gut inflammation accompanied by areas of ulceration (Fig. 1). Mucosal healing is becoming increasingly important in the clinical management of UC and Crohn’s disease, as well as being used as an end point in clinical MG-132 in vitro trials. Achieving mucosal healing has unequivocally been associated with better outcomes, and

for these reasons, it has become an important treatment goal. There are, however, multiple methods to score endoscopic disease activity in both UC and Crohn’s disease. This article therefore focuses on those used most frequently or that have been validated: the Mayo endoscopic score and the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) for UC and the Crohn’s Disease Endoscopic Index of Severity (CDEIS), the Simple Endoscopic Score for Crohn’s Disease (SES-CD), and the Rutgeerts Postoperative Endoscopic Index for Crohn’s disease. Because indices are complex and potentially confusing, the article follows a standard approach describing the indices in this order. Mucosal healing in the context of IBD refers to the endoscopic assessment of disease activity. Simply stated, mucosal healing should imply the absence of ulceration and erosions.