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Remission

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Remission in Crohn's Disease Defined

The definition of Remission for patients with Crohn's Disease (CD) has long been a matter of debate. This disagreement is in part due to the complicated nature of Crohn's Disease in general in addition to differing viewpoints of what factors are important in determining a patient's Remission status. The importance of which factors should be measured and how they should be weighted are often a point of contention between patient and physician.

Remission is often defined in Crohn's patients in Clinical Trials as having a Crohn's Disease Activity Index (CDAI) Score < 150.

There are multiple categories of remission:

1. Clinical remission, which is the easiest to achieve. This is where you don't have any (or very few) symptoms from your disease.

2. Biochemical remission - This is where blood and stool tests such as CRP, ESR, and fecal calprotectin are normal.

3. Endoscopic remission - this is harder to achieve and where you see mucosal healing on colonoscopy meaning the inflamed mucosa in your intestines has healed.

4. Deep (Stable) remission - a combination of all of the above. Stable Remission, or Deep Remission, is defined as having a CDAI score < 150 AND complete Mucosal Healing (MH). [1][2]

Remission Defined: A Topic of Debate

A standardized definition of the term "Remission" is imperative for clinicians, researchers and patients alike.

How is Remission in Crohn's Disease Induced?

There are multiple ways Remission can be induced in Active, or Flaring Crohn's Disease.
Spontaneous Remission
Treatment with Medication / Drugs
Diet
Vitamins / Supplements
Other

References

1. Sandborn WJ. Achieving deep remission in Crohn's Disease. Accessed August 2012. http://www.ibdcme.tv/library/ppts/Ac...issioninCD.pdf

2. Kakkar A, Wasan SK, Farraye FA. Targeting Mucosal Healing in Crohn's Disease. Gastroenterol Hepatol (N Y). 2011 June; 7(6): 374–380. http://www.ncbi.nlm.nih.gov/pmc/arti.../GH-07-374.pdf

3. D'Haens GR, Fedorak R, Lémann M, Feagan BG, Kamm MA, Cosnes J, Rutgeerts PJ, Marteau P, Travis S, Schölmerich J, Hanauer S, Sandborn WJ. Endpoints for clinical trials evaluating disease modification and structural damage in adults with Crohn's disease. Inflamm Bowel Dis. 2009; 15: 1599–1604. doi: 10.1002/ibd.21034 http://onlinelibrary.wiley.com/doi/1.../ibd.21034/pdf

Popular Threads Discussing Remission



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12-04-2012, 09:27 PM   #1
Susan2
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Join Date: Dec 2011
Location: Geelong, Victoria, Australia
I would like to find out where I stand on the remission continuum but, unfortunately, the CDAI (Crohn's Disease Activity Index) doesn't work for someone with an ileostomy - the first question is:

1. Number of liquid or very soft stools in one week

and my answer for this is "continuous".
11-26-2014, 11:55 PM   #2
CrohnsLifer
 
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Join Date: Nov 2014
Location: Mississauga, Ontario
For me there are 2 determining factors of wellness (I've really given up on remission) - number and urgency of BM's per week - a good week 40+ a bad one 60+ and continuous pain level - lately I average 3 to 6 out of 10 which is a big improvement over past levels.

I have concerns with the idea of "remission" again 2 points -

Point 1 - does it mean drug free? Or drug dependent? And how do you know if you've achieve drug free if you're always on one drug or another?

Point 2 - if you Venn diagram Crohn's symptoms with drug side effects you often have a considerable intersection, so how do you know which is causing which?
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