# Deep mucosal healing in ulcerative colitis: how deep is better?

## TL;DR

This paper reviews the evolving concept of deep mucosal healing in ulcerative colitis and highlights the need for standardized definitions and further research.

## Contribution

The paper provides a comprehensive review of different dimensions of deep mucosal healing and emphasizes the need for large-scale trials to validate its benefits.

## Key findings

- Endoscopic remission is widely used but subject to endoscopist variability.
- Histological remission may be linked to fewer disease flares but is not routinely used.
- A universal definition for deep mucosal healing is currently lacking.

## Abstract

Ulcerative colitis (UC), characterized by its recurrent nature, imposes a significant disease burden and compromises the quality of life. Emerging evidence suggests that achieving clinical remission is not sufficient for long-term remission. In pursuit of a favorable prognosis, mucosal healing (MH) has been defined as the target of therapies in UC. This paradigm shift has given rise to the formulation of diverse endoscopic and histological scoring systems, providing distinct definitions for MH. Endoscopic remission (ER) has been widely employed in clinical practice, but it is susceptible to subjective factors related to endoscopists. And there’s growing evidence that histological remission (HR) might be associated with a lower risk of disease flares, but the incorporation of HR as a routine therapeutic endpoint remains a debate. The integration of advanced technology has further enriched the definition of deep MH. Up to now, a universal standardized definition for deep MH in clinical practice is currently lacking. This review will focus on the definition of deep MH, from different dimensions, and analyze strengths and limitations, respectively. Subsequent multiple large-scale trials are needed to validate the concept of deep MH, offering valuable insights into potential benefits for UC patients.