Full mucosal healing

[Tesscorm]

How is full mucosal healing determined? And, does full mucosal healing mean that there is NO active or chronic inflammation anywhere?

MREs can show inflammation but, if there is microscopic inflammation, would this show in an MRE?

I believe biopsies would indicate if microscopic inflammation is present but only in the very specific spot from which the biopsy section is taken, right? So, if visually, no inflammation is seen, the GI would just randomly select a location to biopsy - couldn't the biopsy sample miss a section of inflammation?

I am assuming that the presence of microscopic inflammation means that full mucosal healing has NOT been achieved.

What do your GIs look for and are there any other tests to confirm mucosal healing?

 

[upsetmom]

Very good questions!!!!!.

 

[xmdmom]

Medical journals seem to define complete mucosal healing as an absence of ulcerations on endoscopy in the ileum and colon.

 

[DustyKat]

These are only my ideas Tess:

How is full mucosal healing determined? And, does full mucosal healing mean that there is NO active or chronic inflammation anywhere?

I think mucosal healing is generally thought to be an absence of visual data that indicates disease i.e. no ulcers or erosions as it is these type of features that indicate damage has progressed beyond the superficial. So scopes/pill cam. BUT exactly what mucosal healing constitutes is is up or debate.

MREs can show inflammation but, if there is microscopic inflammation, would this show in an MRE?

No, an MRE will not show microscopic inflammation.

I believe biopsies would indicate if microscopic inflammation is present but only in the very specific spot from which the biopsy section is taken, right? So, if visually, no inflammation is seen, the GI would just randomly select a location to biopsy - couldn't the biopsy sample miss a section of inflammation?

Yes it could.

I am assuming that the presence of microscopic inflammation means that full mucosal healing has NOT been achieved.

It has been suggested that mucosal healing and microscopic inflammation are not linked as you can have mucosal whilst microscopic inflammation is present.

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This is a very good article about mucosal healing Tess:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277196/

And this is a thread by David about the topic:

http://www.crohnsforum.com/showthread.php?t=36253

Dusty.

 

[Tesscorm]

Thanks for the links Dusty! Great info!

Can you just confirm below??...

MREs can show inflammation but, if there is microscopic inflammation, would this show in an MRE?

No, an MRE will show microscopic inflammation.

Did you mean No, MRE will NOT show...

 

[DustyKat]

:eek2: Not is right! Ugh! I will edit. Thanks!

 

[xmdmom]

You may be interested in table 1 of this article http://gastro.ucsd.edu/fellowship/m...erences/MRE vs CTE in Small Bowel Crohn's.pdf that looked at MRE, CTE, ileoscopy and mucosal biopsy in the same patients.

 

[Tesscorm]

Thanks, xmdmom , for the link. Haven't read the entire article (weekend reading ) but Table 1 really does highlight that no one test can be considered conclusive.