What does it mean to be in remission

Did you know there are multiple types of remission in IBD?

Clinical remission

This is the lowest level of remission where you are symptom free but may still have inflammation.

Since symptoms can be poorly correlated with disease activity, you should always keep getting your inflammation checked regardless of whether or not you are experiencing symptoms.

If you are in clinical remission but still have inflammation, you are at a higher risk of long-term disease complications including flares and surgeries.^1-2

Biochemical remission

This level of remission means that your inflammatory stool tests (fecal calprotectin) and blood tests (c-reactive protein or CRP, and erythrocyte sedimentation rate or ESR) are within normal limits.

{{inline-cta-blog}}

Surgical remission

When you’re in remission because your doctor removed the inflamed part or parts of your bowel.

Endoscopic remission

This level of remission means that your doctor didn’t see any visible signs of active inflammation during a colonoscopy, sigmoidoscopy, or endoscopy.

If you’re in endoscopic remission, there may still be microscopic inflammation not visible to the eye.

This level of remission is associated with improved outcomes, including long-term (≥50 weeks) clinical remission in Crohn's disease and ulcerative colitis, lower need for steroids in ulcerative colitis, and reduced need for surgery/hospitalizations in both Crohn’s disease and ulcerative colitis.^1-2

Histological remission

You’re in histological remission when the doctor takes biopsies during your colonoscopy, sigmoidoscopy, or endoscopy and those biopsies don’t show any active inflammation under the microscope. 

Deep remission

Although there is no standardized definition of the term deep remission, this term is often used to describe a combination of clinical, endoscopic, and/or histologic assessments.³

More research is needed to determine whether or not this level of remission provides any benefits over endoscopic remission.⁴

Being in deep remission also doesn’t mean that you’re cured of your Crohn’s or colitis, so it’s important to continue working with your medical team to reduce the risk of active disease in the future.

Intestinal barrier healing / functional remission

This is a new level of remission that is beginning to be analyzed using confocal laser endomicroscopy to determine the integrity of the intestinal barrier.

A recent study involving 181 patients (100 with Crohn’s disease and 81 with ulcerative colitis) found that barrier healing was superior to both endoscopic and histologic remission for predicting disease outcomes including flares, hospitalizations, and surgeries.⁵

More research is needed to determine the implications of deep remission and intestinal barrier healing on long-term outcomes for IBD patients.

{{inline-cta-blog}}