What Remission Really Means in UC
If you have ulcerative colitis (UC, one of the main types of inflammatory bowel disease), you likely already know there is unfortunately no cure. However, the good news is that there is a very real possibility of remission—for weeks, months, or even years. It can be a little confusing, though, because there are technically three different types (or levels) of remission. And the treatment goalposts for UC have changed in recent years, thanks to rising popularity of the “treat to target” approach. The ultimate goal is no longer a lack of symptoms, but a complete absence of inflammation in the colon (hello, praise hands emoji!). Here’s what that might mean for you:
What Is Remission, Exactly?
During remission, UC symptoms improve. But remission itself is difficult to define, says Shannon Chang, M.D., a gastroenterologist at NYU Langone’s Inflammatory Bowel Disease Center in New York City. For starters, there are three different types: clinical, endoscopic, and histologic remission. We're going to look at each one.
Clinical Remission Generally Means No Symptoms
When the symptoms of UC are gone (or mostly gone), that’s considered clinical remission, explains Steve Serrao, Ph.D., the division chief in gastroenterology at Riverside University Health System in Moreno Valley, CA. Gastroenterology societies use guides such as the Simple Clinical Colitis Activity Index to gauge UC activity, and doctors also recommend using a stool/food diary to log symptoms. Check out apps like mySymptoms Food Diary ($3.99) to help you collect this information.
But No Symptoms Doesn’t Mean No Inflammation
Although patients deemed to be in clinical remission feel fine, about 30% to 50% may still have inflammation in the colon, says Ahmad Kamal, M.D., a gastroenterologist with Santa Clara Valley Medical Center in Fruitdale, CA. “This type of ‘silent’ inflammation can be dangerous because it puts people at elevated risk of colon cancer or future flare-ups of disease,” he explains. Inflammation may be detected via colonoscopy, and in the meantime it’s important not to stop or decrease medications without talking to your doctor—even if you are feeling okay.
A Colonoscopy Is Needed to Establish Endoscopic Remission
If a patient with no symptoms has a normal-appearing colonoscopy, they are considered to be in endoscopic remission. “These patients are at a lower risk of having recurrent symptoms than patients in only clinical remission,” Dr. Kamal says. However, he adds that one-third of patients in endoscopic remission have evidence of microscopic disease activity when biopsies are taken from their colon. Even in endoscopic remission, it’s crucial to continue taking your prescribed meds to prevent future inflammation in the colon.
Histologic Remission Is the Ultimate Goal—For Most People
A patient who has no evidence of inflammation even when parts of their colon tissue are biopsied and examined under a microscope is regarded as being in histologic remission, also known as deep remission. “Patients in deep histologic remission are at the lowest risk for requiring surgery or developing colon cancer over the next several years,” Dr. Kamal says. However, this isn’t necessarily the goal of every UC patient. “A patient and their doctor might decide against a biopsy if the patient doesn’t want to take an aggressive approach to therapy,” Dr. Kamal says.
A Few Colonoscopies Is Standard
Generally, patients have a colonoscopy when they first get symptoms of UC – this helps their doctor rule out Crohn’s disease, infectious colitis, and other similarly-presenting conditions, Dr. Kamal says. After treatment, another colonoscopy helps determine whether they’re in deep remission. The need for any further colonoscopies depends on various factors, including symptoms, the age of the patient, and their therapy goals, Dr. Kamal explains. “If deep remission is confirmed, they might not need another colonoscopy for eight to ten years,” he adds. Thereafter, an annual colonoscopy is recommended for patients with a history of extensive UC, to monitor for colon cancer.
Can I Stop Taking My Meds in Deep Remission?
In a word: no. The key to remaining in remission is sticking to your recommended treatment plan. A study published in PLoS One found that people in remission who stopped taking their meds were five times more likely to relapse. Treatments that may help achieve or maintain UC remission include aminosalicylates, drugs that reduce inflammation in the lining of the colon, and immunomodulators, meds that modify the immune system in order to decrease the body’s inflammatory response. All treatments come with potential side effects, and it can take time to find the one that works best for you.
Will My UC Symptoms Come Back?
Because UC is a chronic disease, it’s possible that you could have a flare-up in the future, even after a long period in remission. And even if you stay in remission, you might still have symptoms like diarrhea, abdominal pain, or fatigue from time to time. It can be difficult to tell whether these symptoms are caused by UC, or whether they’re caused by something else, like irritable bowel syndrome (IBS), an infection, small intestinal bacterial overgrowth, or even dietary changes, Dr. Chang says. If you do experience any symptoms, you should discuss them with your doctor.
Prevent Relapse By Keeping Healthy
Stay healthy by drinking plenty of water, eating a varied, nutritious diet, and avoiding foods and drinks that are known triggers for your UC. One study, published in Inflammatory Bowel Diseases, found that short-term stress may increase the risk of UC relapse among people in remission. There’s also some evidence that regular exercise can help reduce the likelihood of a relapse. A study published in Inflammatory Bowel Diseases found that patients with UC who had higher exercise levels at the start of the study were less likely to develop active disease six months later.
- Simple Clinical Colitis Activity Index: Gut. (1998). “A simple clinical colitis activity index.” pubmed.ncbi.nlm.nih.gov/9771402/
- Staying in Remission: PLoS One. (2017). “The risk factor of clinical relapse in ulcerative colitis patients with low dose 5-aminosalicylic acid as maintenance therapy: A report from the IBD registry.” journals.plos.org/plosone/article?id=10.1371/journal.pone.0187737
- UC Medications: Crohn’s & Colitis Foundation. (n.d.). “Medication Options for Ulcerative Colitis.” crohnscolitisfoundation.org/what-is-ulcerative-colitis/medication
- Stress and UC: Inflammatory Bowel Diseases. (2013). “Short-Term Stress, but Not Mucosal Healing Nor Depression Was Predictive for the Risk of Relapse in Patients with Ulcerative Colitis: A Prospective 12-Month Follow-up Study.” academic.oup.com/ibdjournal/article/19/11/2380/4603082
- Exercise and UC: Inflammatory Bowel Diseases. (2016). “Exercise Decreases Risk of Future Active Disease in Inflammatory Bowel Disease Patients in Remission.” ncbi.nlm.nih.gov/pmc/articles/PMC4402239/