For those with Crohn’s and Ulcerative Colitis remission is their long-term goal. Remission can be defined as a period of time where the patient experiences little or no symptoms of their chronic illness. Many IBD patients do not realize there are actually five different types of remission. I have personally had UC now for seven years and only learned this a few months ago! I want to share it here with you all, as I feel it is important information. After all, knowing is half the battle already won. Let’s take a look at the five types and what defines them.
- Biochemical Remission/ Normalization- This type of remission is when blood or stool tests are taken, examined by a laboratory, and found to come back with no showing hallmark signs of IBD. This can include blood work like CRP (c-reactive protein) that checks inflammation markers or CBC (complete blood count) that can help conclude general health and key biomarkers. The most common stool tests are calprotectin and lactoferrin. These tests check for particular substances released by white blood cells that show inflammation and are associated with disease severity and relapse.
- Clinical Remission- This type of remission is the one we think of the most, and the most commonly understood. Clinical remission occurs when the patient is experiencing very few to no symptoms. This is what many with IBD aim for, but it may not be enough on its own. While having no symptoms is certainly life-changing, it doesn’t mean that you are free of excess inflammation that can cause issues at a later point in time.
- Endoscopic/ Radiographic Remission- Endo meaning internal or within, and scopic representing scope or other medical equipment to look at internal organs. As the name suggests this kind of remission is when a type of scope or other procedure is done and no inflammation is visible. This means all the footage and pictures taken show no signs of active disease or inflammation. Radiographic goes along these lines and simply refers to no signs of inflammation from imaging scans of the GI tract. This is ‘a step up’ if you will, from clinical remission in that aside from not experiencing any symptoms on the outside, active disease and inflammation are not seen on the inside either. This means that the lining of the intestines has undergone mucosal healing and appears normal. This is an exciting achievement, and worth celebrating. There is however one step better which we will discuss next.
- Histologic Remission- This type of remission is usually referred to when biopsies are collected during a type of scope and come back with no sign of inflammation in the tissue itself. This is the ultimate goal of anyone with IBD. It means that the inflammation levels have gone down so much that they are no longer detectable in the tissue. This is associated with longer remission periods and less relapse of disease. This type of remission is often achieved after some time on medication, and so often a big reason it can be reached in the first place. A common mistake of those in Histologic remission is that they stop taking medication because they think they don’t need it anymore. It’s imperative to continue to follow treatment plans and lifestyle changes such as diet to often maintain this type of remission.
- Surgical Remission- This is used to refer to remission that has been achieved after surgery. Whether you have had a colectomy, colostomy, ileostomy, j-pouch, or resection, if you have had surgery for IBD and then experienced remission, this is the type you have had. It is only referred to when remission is achieved after recovery. Surgery for many can lead to this type of remission and can substantially reduce inflammation and symptoms.
While there are several types and it can be confusing at first, I hope that after this read you have a better understanding of the types of remission that can be experienced with IBD. If you don’t currently have a plan laid out with your GI doctor to try to achieve some type of remission, I encourage you to speak to them with your newfound knowledge. Self/patient advocacy is a very important step in the American healthcare system to make sure you are receiving the best care for yourself!
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