The Use of Endoscopy to Follow the Clinical Course of Crohn’s Disease

In contrast to traditional aims in the treatment of Crohn’s disease, recent studies have identified mucosal healing as an important therapeutic goal. Conventional management focused predominantly on achieving clinical remission, without necessarily accomplishing response at a mucosal level. However, evidence has emerged demonstrating that achieving and maintaining mucosal healing can alter the natural history of the disease. Until recently this outcome seemed out of reach for treatment strategies designed only to ameliorate symptoms. This revelation gains pivotal importance when considered in conjunction with the advent of biological agents with the ability to effectively deliver this goal. In this chapter we will present the evidence, which gave rise to this critical change of paradigm. Despite this clear progress, there remain a number of unresolved issues regarding its implications for the monitoring and treatment of patients with Crohn’s disease. For instance, a universally accepted definition for mucosal healing has yet to be agreed. The same is true of the minimal clinically relevant change in endoscopic appearance. There are also practical issues regarding the integration of endoscopic goals into clinical treatment strategies. In this chapter we explore these issues in light of the latest evidence. The endoscopic indices used to objectively quantify disease activity in Crohn’s disease will also be described, along with their development, properties and practical use. Finally, we will make suggestions on how this understanding can be integrated into clinical practice to optimize the management of patients with Crohn’s disease.