What is remission?

[swimbikerun]

What is remission? More specifically, if I have been diagnosed with Crohn's due to ulcers in my TI (terminal ileum) and I go into remission, do the ulcers disappear or do my symptoms go away but ulcers stay?

 

[Caitlyn336]

remission should be no new or active inflammation. So if you are in remission and you have been for a while those ulcers should heal and most symptoms are gone.

 

[cmack]

I agree.

 

[Furrydogmom]

As I understand it, there are two types. Clinical remission is what we usually refer to and is no visible symptoms or inflammation. Histologic remission is the ultimate goal or "true" remission where there is mucosal healing. I think I heard this on a CCFA webcast.

 

[swimbikerun]

Furrydogmom - and they can tell that has been achieved how? Mucosal healing?

 

[Scipio]

Furrydogmom is correct. Clinical remission = symptoms have cleared up. The ulcers may or may not still be there. Histological remission = ulcers and other signs inflammation in the tissue have cleared up.

They can tell whether you have achieved this in the terminal ileum or the colon via ileocolonoscopy where they both take a visual look and collect biopsies to confirm the remission.

 

[swimbikerun]

Scipio - so how often do they attempt to confirm histological remission? This would mean knocking you out, etc. correct? If that is true wouldn't think they would go this far very often and just be content with clinical remission with possible histological remission. Also, does it matter if it is clinical vs histological in terms of how they continue to treat you? Are you still on the same meds regardless?

 

[teeny5]

I have been in remission for a few years. All of my ulcers are gone according to latest colonoscopy (I have scars where many of them were), minimal symptoms, minimal pain if any most days, all blood work is normal. I had a colonoscopy to diagnose disease and then one to confirm remission. I believe he said every few years I would still have one done even in remission to check any polyps or anything that might be going on. The only way they really know what's going on in there is with the colonoscopy.
I take Colazal everyday as a maintenance medication. My Dr said I will need to take meds for the rest of my life. The idea is that the maintenance meds keep the inflammation down. When I have a flare it will be easier to treat because it should not be as big...theoretically. He believes if I was not taking the maintenance meds a flare might come on much stronger, needing much stronger meds, and then would also take longer to get rid of. Makes sense to me, and it's been working so far so we'll stick with it.
When I was flaring I took Entocort to get the inflammation down and then he took me off of it (I took maintenance meds with the Entocort). If the inflammation got out of control again, then back on he Entocort. But, I was lucky and the Entocort worked right away. I still see my Dr a minimum of every 6 months even in remission. I still have some days I don't feel great or when diarrhea comes around, but unless it continues or gets worse I don't notify him as it has become what is normal for me.

 

[Scipio]

Scipio - so how often do they attempt to confirm histological remission? This would mean knocking you out, etc. correct? If that is true wouldn't think they would go this far very often and just be content with clinical remission with possible histological remission. Also, does it matter if it is clinical vs histological in terms of how they continue to treat you? Are you still on the same meds regardless?

It depends. If your disease is more or less stable they may do a colonoscopy only once a year or maybe even less often. If you are feeling great and all your lab tests a fine, they may not do one at all. But if there is a relapse or the doc thinks there needs to be a change in medication for some reason they will often do one then so that they aren't making these moves "blind."

Plus there are other ways, such as imaging studies - MRE, CT scan, etc., to assess the level of inflammation short of doing a colonoscopy. But those methods of course do not produce a tissue sample that can be assessed under the microscope. They look for bowel wall thickening and other signs of inflammation that may not reflected in the symptoms. But at least they provide some information so that the doc might be able to say "Yes, your symptoms are down but there are still signs of active disease."