Histological healing in IBD: Ready for prime time?

• Published in: Digestive and liver disease 2025-01
• Main Authors: Villanacci, Vincenzo, Del Sordo, Rachele, Mino, Sara, Locci, Giorgia, Bassotti, Gabrio
• Format: Article
• Language: English
• Subjects: Crohn's disease; Histological scores; Microscopic activity; Neutrophils; Ulcerative colitis
• ISSN: 1590-8658; 1878-3562; 1878-3562
• DOI: 10.1016/j.dld.2025.01.039

The main target of treatment in ulcerative colitis and Crohn's disease is to achieve a complete so-called mucosal healing. Various definitions of mucosal healing are available in literature, and the most recent ones include a combination of endoscopic and histological remission. However, the assessment of a complete histological remission is not always univocal. Absence of neutrophil infiltration in the lamina propria, together with neutrophil-mediated mucosal injuries in crypt and surface epithelium, is considered an important element to define histological remission. Although several histological scoring systems have been proposed to differentiate active vs quiescent disease and to evaluate the therapeutic efficacy, most of them are subjective and complex to employ in the daily diagnostic routine. For this reason, to simplify histologic scoring attempts have been made by introducing simplified scores, based on the evaluation of neutrophils and their mucosal localization. Artificial intelligence models are also being developed to standardize histological assessment of mucosal healing, and new biomarkers, such as claudin- 2, are emerging to simplify this latter aspect.