Is histological healing a feasible endpoint for ulcerative colitis?

Expert Rev Gastroenterol Hepatol. 2021 Jan 22. doi: 10.1080/17474124.2021.1880892.Online ahead of print.

Timo Rath 1, Raja Atreya 1, Markus F Neurath 1


Author information

  • 1Department of Internal Medicine 1, Division of Gastroenterology, Ludwig Demling Endoscopy Center of Excellence, Friedrich-Alexander-University , Erlangen- Nuernberg, Germany.


Introduction: Currently, treatment goals in ulcerative colitis aim to achieve clinical remission and endoscopic mucosal healing. Emerging evidence suggests that histologic assessment of inflammation is a sensitive marker that can outcompete mucosal healing in predicting the clinical course of disease in patients with ulcerative colitis. Based on this, histologic healing is frequently included as a secondary endpoint in pharmacological trials.

Areas covered: We introduce currently used clinical and endoscopic treatment goals, summarize commonly used histologic scoring systems and then provide an overview on the relevance of histologic healing on the outcome in patients with ulcerative colitis. Finally, we review the efficacy of existing UC therapies for inducing histologic remission.

Expert opinion: Histologic healing is achievable in a substantial portion of UC patients. Further, histologic healing is, as consolidated by several meta-analyses, associated with better disease outcome compared to clinical remission and/or endoscopic healing. However, before becoming a widely acceptable treatment endpoint, consensus definitions for histologic healing and the technical aspects as well as for the timing for obtaining biopsies are needed. And finally, we need more evidence to show that resolution of microscopic inflammation as a means of therapy change or dose escalation is indeed a superior endpoint.

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