Guidelines Developed for Crohn Disease Management With Biomarkers

FRIDAY, Dec. 15, 2023 (HealthDay News) -- For patients with Crohn disease (CD), biomarkers can inform disease management in symptomatic and asymptomatic disease, according to a clinical practice guideline issued by the American Gastroenterological Association and published in the December issue of Gastroenterology.

Ashwin N. Ananthakrishnan, M.B.B.S., from Massachusetts General Hospital and Harvard Medical School in Boston, and colleagues developed guidelines relating to the use of biomarkers for managing CD. Evidence on the performance of fecal calprotectin, serum C-reactive protein (CRP), and Endoscopic Healing Index was reviewed.

The authors developed 11 conditional recommendations. The panel suggested use of a biomarker- and symptom-based monitoring strategy over symptoms alone for patients with CD in symptomatic remission; a fecal calprotectin <150 µg/g and normal CRP rules out active inflammation, avoiding the need for endoscopic evaluation for assessment of disease activity. In this setting, elevated biomarkers warrant confirmation with endoscopy before adjustment of treatment. Neither normal nor elevated biomarkers alone are sufficiently accurate to determine endoscopic activity in patients with CD with mild symptoms. Elevated fecal calprotectin or serum CRP suggests endoscopic activity, precluding routine endoscopic assessment for disease activity, in patients with moderate-to-severe symptoms. For patients with CD in surgically induced remission, a normal fecal calprotectin reliably rules out endoscopic recurrence in low-risk patients on pharmacologic prophylaxis. Endoscopic assessment is suggested for establishing postoperative recurrence in other postoperative settings.

"Based on this guideline, biomarkers are no longer considered experimental and should be an integral part of inflammatory bowel disease care," Ananthakrishnan said in a statement. "Biomarkers are usually easier to obtain, less invasive, more cost-effective than frequent colonoscopies and can be assessed more frequently for tighter disease control."

Several authors disclosed ties to the biopharmaceutical industry.

Clinical Practice Guideline