Role of Biomarkers for the Management of Crohn’s Disease
Publication Date: November 15, 2023
Last Updated: November 17, 2023
Patients with CD in symptomatic remission
In patients with CD in symptomatic remission, the AGA suggests a monitoring strategy that combines biomarkers and symptoms, rather than relying on symptoms alone. ( Low , Conditional (weak) )
Comment: Patients who place a higher value on avoiding the burden of biomarker testing, over a potentially higher risk of flare and disease progression caused by missing subclinical inflammation, may reasonably choose interval symptom-based monitoring.
612
In patients with CD in symptomatic remission with recent confirmation of endoscopic remission (without any change in clinical status, on stable therapy), the AGA suggests using fecal calprotectin <150 μg/g and/or CRP <5 mg/L (or below cutoff for normal range for the laboratory) to rule out active inflammation, and avoid routine endoscopic assessment of disease activity.
(Low to Moderate, Conditional (weak) )612
In patients with CD in symptomatic remission without recent confirmation of endoscopic remission, the AGA suggests endoscopic evaluation to rule out active inflammation, rather than relying solely on fecal calprotectin or CRP. (Low to Moderate, Conditional (weak) )
612
In patients with CD in symptomatic remission, with elevated biomarkers of inflammation (fecal calprotectin >150 μg/g, CRP >5 mg/L), the AGA suggests endoscopic assessment of disease activity rather than empiric treatment adjustment. ( Low , Conditional (weak) )
612
Patients with symptomatically active CD
In patients with symptomatically active CD, the AGA suggests a biomarker-based assessment and treatment adjustment strategy, rather than relying on symptoms alone. ( Moderate , Conditional (weak) )
Comment: Patients who place a higher value on avoiding the burden of biomarker testing, over a potentially higher risk of over- or undertreatment if relying only on symptoms, may consider choosing interval symptom-based treatment adjustment when being treated for active symptoms.
612
In patients with CD with mild symptoms and elevated biomarkers of inflammation (fecal calprotectin >150 μg/g, CRP >5 mg/L), the AGA suggests endoscopic assessment of disease activity rather than empiric treatment adjustment. ( Very Low , Conditional (weak) )
612
In patients with CD with mild symptoms and normal biomarkers of inflammation (fecal calprotectin <150 μg/g, CRP <5 mg/L), the AGA suggests endoscopic assessment of disease activity rather than empiric treatment adjustment. ( Very Low , Conditional (weak) )
612
In patients with CD with moderate to severe symptoms, the AGA suggests using fecal calprotectin >150 μg/g or CRP >5 mg/L to rule in active inflammation and inform treatment adjustment and avoid routine endoscopic assessment of disease activity. (Low to Moderate, Conditional (weak) )
612
In patients with CD with moderate to severe symptoms with normal biomarkers of inflammation (fecal calprotectin <150 μg/g, CRP <5 mg/L), the AGA suggests endoscopic assessment of disease activity rather than empiric treatment adjustment. ( Low , Conditional (weak) )
612
Patients with CD in surgically induced remission
In asymptomatic patients with CD after surgically induced remission within the past 12 months, who are at low risk of postoperative recurrence or who have 1 or more risk factors for recurrence but are on postoperative pharmacologic prophylaxis, the AGA suggests using fecal calprotectin <50 μg/g to avoid routine endoscopic assessment of disease activity. ( Moderate , Conditional (weak) )
Comment: Patients, particularly those with multiple prior surgeries, and/or with failure of multiple advanced therapies before surgery, who value more accurate assessment of endoscopic recurrence over the inconvenience and costs of colonoscopy, may reasonably choose endoscopic assessment of disease activity within 12 months after surgery.
612
In asymptomatic patients with CD after surgically induced remission within the past 12 months, who are at high baseline risk of recurrence and are not receiving postoperative pharmacologic prophylaxis, the AGA suggests endoscopic evaluation, rather than relying solely on biomarkers, for assessing endoscopic recurrence. (Low to Moderate, Conditional (weak) )
612
EHI (Monitr) in patients with CD
In patients with CD, the AGA suggests neither in favor of nor against the use of EHI (Monitr) for monitoring inflammation and treatment decisions. ( Evidence Gap , No recommendation )
612
In patients with CD, the AGA makes no recommendation in favor of, or against, a biomarker-based monitoring strategy over an endoscopy-based monitoring strategy to improve long-term outcomes. ( Evidence Gap , No recommendation )
612
- AGA: American Gastroenterological Association
- CD: Crohn's Disease
- CRP: C-reactive Protein
- EHI: Endoscopic Healing Index
- IBD: Inflammatory Bowel Disease
The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.
Title
Role of Biomarkers for the Management of Crohn’s Disease
Authoring Organization
American Gastroenterological Association
Publication Month/Year
November 15, 2023
Last Updated Month/Year
May 8, 2024
Country of Publication
US
Document Objectives
Biomarkers are used frequently for evaluation and monitoring of patients with Crohn’s disease (CD). This American Gastroenterological Association (AGA) guideline is intended to support practitioners in decisions about the use of biomarkers for the management of CD. In patients with CD, fecal calprotectin and serum CRP can inform disease management in both asymptomatic and symptomatic disease. Discordance between symptom assessment and biomarker value may merit endoscopic evaluation for confirmation of status of disease activity.
Target Patient Population
Patients with Crohn's Disease
Target Provider Population
Gastroenterology health care professionals; primary care, emergency, and urgent care providers; patients; and policy makers
Inclusion Criteria
Male, Female, Adolescent, Adult, Child, Older adult
Health Care Settings
Ambulatory, Laboratory services
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening
Diseases/Conditions (MeSH)
D003424 - Crohn Disease
Keywords
biomarkers, Crohn's disease, IBD, CD, crohns disease
Methodology
Number of Source Documents
38
Literature Search Start Date
November 20, 2021
Literature Search End Date
August 31, 2022