To understand why histological remission is important, it’s helpful to start with a high-level view of what remission really means. With UC and other inflammatory bowel diseases, there are three types: clinical, endoscopic, and histological.
Clinical Remission
With this type, it’s all about how you feel, according to Rudolph Bedford, MD, a gastroenterologist at Providence Saint John’s Health Center in Santa Monica, California. This is the current standard for remission and tracks symptoms and their effect on everyday activities, he says.
“Clinical remission means the patient isn’t experiencing disruptive flares of their ulcerative colitis, such as abdominal pain, urgency, or fatigue,” he explains. “This is a subjective measure, but it’s easy to track and is something a patient can assess on their own without any invasive testing, so it’s the most used for monitoring UC overall.”
Endoscopic Remission
Whether there’s clinical remission or not, a gastroenterologist may order a scan like a colonoscopy, endoscopy, or sigmoidoscopy to look for signs of damage and ulceration in the gastrointestinal tract.
Endoscopic remission goes beyond clinical remission because it provides evidence of whether the intestinal lining is healing or if further treatment is necessary, says Dr. Bedford. Patients may have endoscopic evidence of inflammation without any symptoms.
Histological Remission
“Histologic remission indicates that there’s a deeper level of healing than an endoscopic remission,” says Bedford. “This is a relatively new measurement, as we transition away from looking only at symptoms. This has the potential to give us more information about the level of inflammation for someone with ulcerative colitis.”