What exactly is remission?
- Thread starter cdnrose
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remission can have more than one meaning. From the patient's point of view remission means the symptoms went away. Doctors also consider relief from symptoms to be a key goal of therapy. But GIs also have a target of achieving what is called "mucosal healing," which is basically seeing a normal, healthy-looking colon or terminal ileum when viewed through the endoscope.
A healed mucosa is often regarded as a "true" remission, and relief of symptoms is the hoped-for outcome of achieving mucosal healing. But it doesn't always work out quite that way. The appearance of the mucosa and the severity of symptoms are not always aligned. The patient could be feeling pretty good but the endoscope still shows inflammation smoldering away in the background. Or conversely, the colon could look perfectly healed but the patient is still suffering a lot of diarrhea and pain - possibly due to an overlay of Irritable Bowel Syndrome, or an intestinal bacterial infection, or Crohn's inflammation farther up in the small bowel that could not be seen via endoscopy.
So the concept of remission is not clear cut. It can be assessed in multiple ways.
A healed mucosa is often regarded as a "true" remission, and relief of symptoms is the hoped-for outcome of achieving mucosal healing. But it doesn't always work out quite that way. The appearance of the mucosa and the severity of symptoms are not always aligned. The patient could be feeling pretty good but the endoscope still shows inflammation smoldering away in the background. Or conversely, the colon could look perfectly healed but the patient is still suffering a lot of diarrhea and pain - possibly due to an overlay of Irritable Bowel Syndrome, or an intestinal bacterial infection, or Crohn's inflammation farther up in the small bowel that could not be seen via endoscopy.
So the concept of remission is not clear cut. It can be assessed in multiple ways.
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^Agreed.
There are different types of remission. Clinical remission is an absence of symptoms and blood work good. Then there is endoscopic remission which is, of course, visually the bowel looks pristine. Histological remission is at the cellular level.
For a long time GIs treated to achieve clinical remission. Now they have discovered that deep, stable remission with mucosal healing leads to longer states of remission. It includes clinical, endoscopic and histological and is now the standard most GIs try to achieve.
There are different types of remission. Clinical remission is an absence of symptoms and blood work good. Then there is endoscopic remission which is, of course, visually the bowel looks pristine. Histological remission is at the cellular level.
For a long time GIs treated to achieve clinical remission. Now they have discovered that deep, stable remission with mucosal healing leads to longer states of remission. It includes clinical, endoscopic and histological and is now the standard most GIs try to achieve.
My Dr asked me what remission looked like to me, I said when I can eat a bowl of Cheerios or Oatmeal. And I would like to have a salad. He looked at me like I was nuts! If I can't expand my diet anymore than I eat during a flare, why take the meds?
I am sick right now and may have a bit of a bad attitude!
Lauren
I am sick right now and may have a bit of a bad attitude!
Lauren
My Dr asked me what remission looked like to me, I said when I can eat a bowl of Cheerios or Oatmeal. And I would like to have a salad. He looked at me like I was nuts! If I can't expand my diet anymore than I eat during a flare, why take the meds?
I am sick right now and may have a bit of a bad attitude!
Lauren
I am sick right now and may have a bit of a bad attitude!
Lauren
