This document discusses mucosal healing (MH) and deep remission (DR) as therapeutic goals in treating inflammatory bowel disease (IBD). It defines MH in ulcerative colitis as having an endoscopic Mayo score of 0-1, with or without histological inflammation. DR is defined as achieving MH along with clinical, structural, and functional remission. Various endoscopic imaging techniques can help assess MH and DR by examining mucosal structures, crypt openings, and molecular markers of inflammation and intestinal function. The goal of IBD treatment has shifted from just clinical remission to also achieving MH and DR.

1. Kurdistan Board GEH/GIT Surgery J Club 2022
Supervised by Professor Dr. Mohamed Alshekhani.

2. Introduction:
 The goal of IBD treatment is to maintain ‘remission’ status as long as
possible lacking any radical treatment.
 Clinical remission is the primary goal of IBD, but 39–60% of those achieve
clinical remission,still show an endoscopically active status.
 MH considered a primary goal in IBD &crucial factor associated with
long-term non-relapsing &non-operative periods.
 Various endoscopic procedures, including magnifying endoscopy, image-
enhanced endoscopy (IEE) & ultra-high magnifying endoscopy, applied to
achieve more precise / detailed assessments of mucosal inflammation.
 The deep remission DR indicate more reliable remission than typical,
proposed as a treatment target, its definition is not as clear as that of MH.

3. MH in UC:DEFINITIONS
 Absence of friability, blood, erosions&ulcers in all visualized segments in
the colonic mucosa or Mayo endoscopic score (MES) 0–1, regardless of
histological findings,.
 MH is associated with long-term clinical remission ,lower rates of
hospitalization& colectomy.
 Histo-endoscopic mucosal healing, achieving both endoscopic improvement
(Mayo endoscopy subscore of 0 or 1)&histologic improvement (neutrophil
infiltration in <5% of crypts, no crypt destruction& no erosions,
ulcerations, or granulation tissue).
 The importance of histological remission is increased when evaluating
therapeutic efficacy in UC.

4. DR in UC:Definitions
 1.Endoscopically healed mucosa (Mayo score 0) & a normalized mucosal
TNF gene expression induced by anti-TNF treatment.
 2.The combination of MH,clinical, structural& functional remission.
 Structural remission;improvement of the crypt formation, can be
estimated by evaluating crypt opening using CLE& endocytoscopy (ECS).
 The function can be assessed by molecular imaging targeting epithelial
repair and proliferation-associated factors (e.g. Wnt, trefoil factor,
transforming growth factor b, notch BMP) & differentiation-&barrier
function-related factors (FUT2, MUC1, MUC19&NOD2).

14. Conclusion:
 The therapeutic goal in IBD shifted from controlling the clinical activity
alone to managing other associated problems.
 Mucosal healing (MH) & deep remission (DR) are advocated/ regarded as
new therapeutic goals.
 MH includes histological structures &functional factors +clinical remission
 The classifications of white-light imaging (e.g. Mayo endoscopic subscore,
UCEIS, CD Endoscopic Index of Severity,simple Endoscopic Score-CD)
are now widely used to assess the severity &MH of inflammation in IBD.
 In ulcerative colitis, magnifying chromoendoscopy is useful to assess the
MH of inflammation while other IEE, as NBI is not.
 Endocytoscopy&CLE can estimate MH with more precision through
observing the details of superficial structures, as crypt openings& partially
assess the mucosal function by detecting fluorescence leakage.
 Molecular imaging detect the molecules associated with inflammation,
intestinal regeneration/differentiation&various functions including the
intestinal barrier and mucus secretion.