Disease clearance in immune-mediated gastrointestinal disorders: A new standard or a semantic trap?

Abstract

Immune-mediated gastrointestinal disorders, including eosinophilic oesophagitis, coeliac disease, and inflammatory bowel disease, are increasingly managed with therapeutic goals that extend beyond symptom control. Among these, the concept of disease clearance - defined as remission across multiple domains of disease activity - is gaining attention and may be applicable across these disorders. However, important challenges remain, including lack of standardisation, uncertain long-term clinical relevance, and limited evidence regarding feasibility and cost-effectiveness in routine practice. Moreover, the term clearance may itself be misleading in chronic immune-mediated diseases, where current therapies suppress inflammation rather than eradicate the underlying pathogenic process. Future therapeutic strategies will likely move beyond inflammation control towards immune reprogramming, incorporating additional dimensions such as barrier and molecular healing. In this evolving scenario, what currently represents an aspirational construct may progressively approach a clinically meaningful therapeutic reality.