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First Comprehensive Guideline Advocates Biomarker Utilization in Crohn’s Disease Monitoring

NextEdge Admin

25 Nov 2023

3 min 16 sec

The American Gastroenterological Association (AGA) has released a groundbreaking evidence-based guideline recommending the incorporation of blood and stool-based biomarkers in the management of Crohn’s disease, a prevalent form of inflammatory bowel disease (IBD) affecting approximately 2.74 million individuals in the United States. The guideline, published in Gastroenterology, emphasizes the significance of biomarkers, such as C-reactive protein (CRP) in blood and fecal calprotectin (FCP) in stool, as tools for assessing inflammation levels and determining the status of Crohn’s disease.

Traditionally, patient symptoms may not consistently align with endoscopic findings, making biomarkers crucial for a more comprehensive understanding of the disease process. AGA recommends utilizing biomarkers alongside colonoscopy and imaging studies to enhance the precision of diagnosis and treatment decisions. Guideline author Siddarth Singh, MD, MS, from the University of California, San Diego, emphasizes the utility of biomarkers in monitoring inflammation and guiding decision-making for Crohn’s disease patients.

For patients in remission, the guideline suggests checking CRP and FCP levels every six to 12 months, with the tests proving most effective when previous biomarker levels correlated with endoscopic assessments of disease activity. In cases of active symptoms, particularly increased diarrhea and abdominal pain, the recommendation is to check CRP and FCP every two to four months to guide treatment adjustments. Before implementing significant treatment changes, healthcare professionals are advised to consider repeating endoscopic or radiologic assessments.

The guideline also addresses post-surgery scenarios, where FCP may be useful in monitoring patients at low risk for disease recurrence. However, the document underscores the importance of relying on radiologic or endoscopic assessments when suspecting post-operative recurrence rather than solely depending on biomarkers.

According to guideline author Ashwin Ananthakrishnan, MBBS, MPH, from Massachusetts General Hospital, this guideline signifies a paradigm shift by establishing biomarkers as a fundamental component of IBD care. He emphasizes the practical advantages of biomarkers—ease of obtainment, less invasiveness, cost-effectiveness compared to frequent colonoscopies—and underscores their potential for tighter disease control, leading to improved long-term outcomes for Crohn’s disease patients.