Table of ContentsView AllTable of ContentsUnderstanding RemissionTypesInflammationTreatment
Table of ContentsView All
View All
Table of Contents
Understanding Remission
Types
Inflammation
Treatment
Clinical remission of IBD (defined as symptoms are under control) is not the only goal of treatment. The long-term goals of treatment include:Symptoms (such as bloody stool, bowel urgency, pain and fatigue) are under controlNo evidence of active disease (such as ulcers or bleeding)No inflammation at the tissue levelFor many people withinflammatory bowel disease (IBD), remission might come about pretty quickly—but for some, it may take time, and trials of one or more drugs, and/or surgery.VOISIN / PHANIE / Getty ImagesUnderstanding RemissionRemission in IBD is a broader concept than a reduction of symptoms. Getting control of symptoms is the most important factor in improving quality of life in the short term. Reducing symptoms—such as abdominal pain, diarrhea, orbloody stools—will make you feel much better.However, there could be other processes still going on with your IBD, even if some or all of your symptoms are gone. You can have IBD inflammation even if you feel better. Inflammation is a sign that IBD could have the potential to lead to more serious complications.With ulcerative colitis, It is estimated that In a typical year:48% of people will be in remission.30% will have mild disease activity.20% will have moderate disease activity.1% to 2% will have severe disease.With Crohn’s disease, medical and/or surgical treatment results in:50% of people achieve remission or have mild disease over the next five years.45% of those in remission will remain free of relapse over the next year.35% will have one to two relapses.11% will have chronically active disease.Different Types of RemissionThere isn’t a consensus about the exact definition of remission in IBD. Different gastroenterologists and IBD centers might use different criteria. There are, however, several scoring tools that your healthcare provider might use to determine if you’ve achieved remission.Some of the types of remission include:Biochemical remission:Laboratory tests done on the blood or the stool don’t show any of the hallmark signs of IBD (no high values of the inflammatory markers including c-reactive protein (CRP) and/or fecalcalprotectin).Clinical remission:The symptoms of IBD have lessened to the point that they’re mostly absent or gone.Endoscopic remission:No inflammation is seen during acolonoscopyor asigmoidoscopywhen your healthcare provider can see the lining of your digestive tractHistologic remission:When a biopsy is taken and examined, no inflammation is seen.Surgical remission:There is a lack of active disease following surgical resection when it leads to substantially reduced inflammation or symptoms.Why Clinical Remission Might Not Be EnoughClinical remission is certainly important because it means feeling better. The symptoms of IBD can be so troublesome that they prevent you from socializing or going to work or school.However, it’s increasingly being understood that remission should include more than control of symptoms. Getting to what’s called “deep” remission is another goal.One 2013 study showed that 45% of people with ulcerative colitis who are in clinical remission have inflammation that can be found during endoscopy.The problem with this is that inflammation is associated with a risk of various other adverse outcomes, such as:A relapse of ulcerative colitisHigher risk of needing IBD surgery in the futureIncreased risk of colon cancerCan a person with IBD live a normal life?IBD is a lifelong condition, but treatments are available to help people lead active lives with long periods of remission.Treating InflammationAchieving deep remission involves controlling inflammation. Treatment with medication and/or dietary adjustments might be needed to control digestive inflammation.MedicationsMost people need one or more medications to reduce inflammation and help the intestinal lining heal. Medications may include:Aminosalicylates(mesalazine and sulfasalazine)Corticosteroids(prednisolone, budesonide, and methylprednisolone)Immunosuppressives(azathioprine, 6-mercaptopurine, methotrexate, cyclosporin, and tacrolimus)Antibiotics(metronidazole, ornidazole, clarithromycin, rifaximin ciprofloxacin, and anti-TB)Biologics(infliximab, adalimumab, and certolizumab pegol)Targeted synthetic small molecules(upadacitinib, etrasimod, ozanimod)There’s a better chance of a good long-term outcome when endoscopy and biopsy show no inflammation in the digestive system.SurgeryOver many years, medications may not be enough to control inflammation and prevent damage to the intestinal tract. In these cases, surgery may be needed to remove damaged parts of the intestines and reconnect the healthy areas.It is estimated that about one-third of people with ulcerative colitis and 70% of people with Crohn’s disease will require surgery in their lifetime.SummaryIt is becoming accepted among IBD specialists that clinical remission is not always enough to optimally manage IBD. Along with symptom control, managing inflammation with medications and surgery when necessary may improve long-term health outcomes.
Clinical remission of IBD (defined as symptoms are under control) is not the only goal of treatment. The long-term goals of treatment include:
For many people withinflammatory bowel disease (IBD), remission might come about pretty quickly—but for some, it may take time, and trials of one or more drugs, and/or surgery.
VOISIN / PHANIE / Getty Images
Remission in IBD is a broader concept than a reduction of symptoms. Getting control of symptoms is the most important factor in improving quality of life in the short term. Reducing symptoms—such as abdominal pain, diarrhea, orbloody stools—will make you feel much better.
However, there could be other processes still going on with your IBD, even if some or all of your symptoms are gone. You can have IBD inflammation even if you feel better. Inflammation is a sign that IBD could have the potential to lead to more serious complications.
With ulcerative colitis, It is estimated that In a typical year:
With Crohn’s disease, medical and/or surgical treatment results in:
Different Types of Remission
There isn’t a consensus about the exact definition of remission in IBD. Different gastroenterologists and IBD centers might use different criteria. There are, however, several scoring tools that your healthcare provider might use to determine if you’ve achieved remission.
Some of the types of remission include:
Why Clinical Remission Might Not Be Enough
Clinical remission is certainly important because it means feeling better. The symptoms of IBD can be so troublesome that they prevent you from socializing or going to work or school.
However, it’s increasingly being understood that remission should include more than control of symptoms. Getting to what’s called “deep” remission is another goal.
One 2013 study showed that 45% of people with ulcerative colitis who are in clinical remission have inflammation that can be found during endoscopy.
The problem with this is that inflammation is associated with a risk of various other adverse outcomes, such as:
Can a person with IBD live a normal life?IBD is a lifelong condition, but treatments are available to help people lead active lives with long periods of remission.
Can a person with IBD live a normal life?
IBD is a lifelong condition, but treatments are available to help people lead active lives with long periods of remission.
Treating Inflammation
Achieving deep remission involves controlling inflammation. Treatment with medication and/or dietary adjustments might be needed to control digestive inflammation.
Medications
Most people need one or more medications to reduce inflammation and help the intestinal lining heal. Medications may include:
There’s a better chance of a good long-term outcome when endoscopy and biopsy show no inflammation in the digestive system.
Surgery
Over many years, medications may not be enough to control inflammation and prevent damage to the intestinal tract. In these cases, surgery may be needed to remove damaged parts of the intestines and reconnect the healthy areas.
It is estimated that about one-third of people with ulcerative colitis and 70% of people with Crohn’s disease will require surgery in their lifetime.
Summary
It is becoming accepted among IBD specialists that clinical remission is not always enough to optimally manage IBD. Along with symptom control, managing inflammation with medications and surgery when necessary may improve long-term health outcomes.
6 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Crohn’s & Colitis Foundation.Partnering with your doctor.Crohn’s & Colitis Foundation of America.The facts about inflammatory bowel diseases.Chang S, Malter L, Hudesman D.Disease monitoring in inflammatory bowel disease. World J Gastroenterol. 2015 Oct 28;21(40):11246-59. doi: 10.3748/wjg.v21.i40.11246Rosenberg L, Lawlor GO, Zenlea T, et al.Predictors of endoscopic inflammation in patients with ulcerative colitis in clinical remission. Inflamm Bowel Dis. 2013 Mar-Apr;19(4):779-84. doi: 10.1097/MIB.0b013e3182802b0eCenters for Disease Control and Prevention.Living with IBD.Crohn’s and Colitis Foundation.IBD medications list.Additional ReadingCrohn’s and Colitis Foundation. “Facts about Inflammatory Bowel Diseases.” crohnscolitisfoundation.org. 1 May 2011.Moss AC. “Residual Inflammation and Ulcerative Colitis in Remission.“Gastroenterol Hepatol (N Y). 2014 Mar; 10: 181–183.Pineton de Chambrun G, Blanc P, Peyrin-Biroulet L. “Current evidence supporting mucosal healing and deep remission as important treatment goals for inflammatory bowel disease.“Expert Rev Gastroenterol Hepatol. 2016 Aug;10:915-927.Reinink AR, Lee TC, Higgins PD. “Endoscopic Mucosal Healing Predicts Favorable Clinical Outcomes in Inflammatory Bowel Disease: A Meta-analysis.“Inflamm Bowel Dis. 2016 Aug;22:1859-1869.Zallot C, Peyrin-Biroulet L. “Deep remission in inflammatory bowel disease: looking beyond symptoms.“Curr Gastroenterol Rep. 2013 Mar;15:315.
6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Crohn’s & Colitis Foundation.Partnering with your doctor.Crohn’s & Colitis Foundation of America.The facts about inflammatory bowel diseases.Chang S, Malter L, Hudesman D.Disease monitoring in inflammatory bowel disease. World J Gastroenterol. 2015 Oct 28;21(40):11246-59. doi: 10.3748/wjg.v21.i40.11246Rosenberg L, Lawlor GO, Zenlea T, et al.Predictors of endoscopic inflammation in patients with ulcerative colitis in clinical remission. Inflamm Bowel Dis. 2013 Mar-Apr;19(4):779-84. doi: 10.1097/MIB.0b013e3182802b0eCenters for Disease Control and Prevention.Living with IBD.Crohn’s and Colitis Foundation.IBD medications list.Additional ReadingCrohn’s and Colitis Foundation. “Facts about Inflammatory Bowel Diseases.” crohnscolitisfoundation.org. 1 May 2011.Moss AC. “Residual Inflammation and Ulcerative Colitis in Remission.“Gastroenterol Hepatol (N Y). 2014 Mar; 10: 181–183.Pineton de Chambrun G, Blanc P, Peyrin-Biroulet L. “Current evidence supporting mucosal healing and deep remission as important treatment goals for inflammatory bowel disease.“Expert Rev Gastroenterol Hepatol. 2016 Aug;10:915-927.Reinink AR, Lee TC, Higgins PD. “Endoscopic Mucosal Healing Predicts Favorable Clinical Outcomes in Inflammatory Bowel Disease: A Meta-analysis.“Inflamm Bowel Dis. 2016 Aug;22:1859-1869.Zallot C, Peyrin-Biroulet L. “Deep remission in inflammatory bowel disease: looking beyond symptoms.“Curr Gastroenterol Rep. 2013 Mar;15:315.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Crohn’s & Colitis Foundation.Partnering with your doctor.Crohn’s & Colitis Foundation of America.The facts about inflammatory bowel diseases.Chang S, Malter L, Hudesman D.Disease monitoring in inflammatory bowel disease. World J Gastroenterol. 2015 Oct 28;21(40):11246-59. doi: 10.3748/wjg.v21.i40.11246Rosenberg L, Lawlor GO, Zenlea T, et al.Predictors of endoscopic inflammation in patients with ulcerative colitis in clinical remission. Inflamm Bowel Dis. 2013 Mar-Apr;19(4):779-84. doi: 10.1097/MIB.0b013e3182802b0eCenters for Disease Control and Prevention.Living with IBD.Crohn’s and Colitis Foundation.IBD medications list.
Crohn’s & Colitis Foundation.Partnering with your doctor.
Crohn’s & Colitis Foundation of America.The facts about inflammatory bowel diseases.
Chang S, Malter L, Hudesman D.Disease monitoring in inflammatory bowel disease. World J Gastroenterol. 2015 Oct 28;21(40):11246-59. doi: 10.3748/wjg.v21.i40.11246
Rosenberg L, Lawlor GO, Zenlea T, et al.Predictors of endoscopic inflammation in patients with ulcerative colitis in clinical remission. Inflamm Bowel Dis. 2013 Mar-Apr;19(4):779-84. doi: 10.1097/MIB.0b013e3182802b0e
Centers for Disease Control and Prevention.Living with IBD.
Crohn’s and Colitis Foundation.IBD medications list.
Crohn’s and Colitis Foundation. “Facts about Inflammatory Bowel Diseases.” crohnscolitisfoundation.org. 1 May 2011.Moss AC. “Residual Inflammation and Ulcerative Colitis in Remission.“Gastroenterol Hepatol (N Y). 2014 Mar; 10: 181–183.Pineton de Chambrun G, Blanc P, Peyrin-Biroulet L. “Current evidence supporting mucosal healing and deep remission as important treatment goals for inflammatory bowel disease.“Expert Rev Gastroenterol Hepatol. 2016 Aug;10:915-927.Reinink AR, Lee TC, Higgins PD. “Endoscopic Mucosal Healing Predicts Favorable Clinical Outcomes in Inflammatory Bowel Disease: A Meta-analysis.“Inflamm Bowel Dis. 2016 Aug;22:1859-1869.Zallot C, Peyrin-Biroulet L. “Deep remission in inflammatory bowel disease: looking beyond symptoms.“Curr Gastroenterol Rep. 2013 Mar;15:315.
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