| Theme |
Therapeutic strategy for Crohn's disease -- Should mucosal healing be a final goal? |
| Title |
Role of endoscopy and imaging study in management of Crohn's disease |
| Author |
Tadakazu Hisamatsu |
Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University |
| Author |
Haruhiko Ogata |
Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University |
| [ Summary ] |
The development of biologics has dramatically changed the strategies used for Crohn's disease therapeutics. Because of this, the goals of treatment have been changed. Crohn's disease should be considered to be a progressive disease which causes "disabilities". Therefore, it is important to improve the long-term prognoses for patients with this disease by employing early therapeutic interventions with agents such as biologics. The term "mucosal healing" is highlighted as being the new goal we should strive to achieve. The term "Mucosal healing" indicates not only symptomatic improvements, but also endoscopically induced healing of ulcerations and inflammation. This is a very attractive concept, however it is necessary to discuss how we judge its implementation in daily clinical practice. Balloon endoscopy and capsule endoscopy can detect minute changes on mucosal surfaces. However, we do not know how we should best assess information obtained. The dramatic progress of cross sectional imaging such as CTs and MRIs, has made it possible to detect mucosal lesions as well as intestinal complications such as fistulas or abscesses. It has become a new task to define whether cross sectional imaging can assess "mucosal healing". Thus, it has not yet been established how we should assess "disease activity" or "mucosal healing" in practicalterms. We should be aware of the characteristics of individual modalities and use them properly improve the long-term prognosis for Crohn's disease. Investigations into the use of these new tools are in their infancy. |