Redefining remission targets in inflammatory bowel disease: The rise of ultrasound remission

Mucosal healing has long been the primary therapeutic goal in inflammatory bowel disease (IBD). Although ileocolonoscopy remains the reference standard to explore this target, the invasiveness and limited acceptability of endoscopic procedures have accelerated a move toward noninvasive, cross-sectional assessments that capture transmural disease. In this context, transmural healing has been proposed as an ambitious target that can be evaluated with several tools, including intestinal ultrasound (IUS). IUS has emerged as a radiation-free, bedside tool that enables real-time monitoring of transmural inflammation in both Crohn’s disease) and ulcerative colitis (UC). However, achieving full transmural healing is uncommon with available therapies and currently carries modest prognostic value in UC. To improve clinical decision-making, several standardized IUS activity indices have been developed to provide a more nuanced readout of disease activity and therapeutic response. In this review, we summarize the current evidence on transmural inflammation in IBD and propose to differentiate ‘ultrasound remission,’ as defined by composite IUS scores, from the traditional definition of complete transmural healing.