Role of Biomarkers for the Management of Crohn’s Disease

Publication Date: November 16, 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

Recommendation Grading

Abbreviations

  • AGA: American Gastroenterological Association
  • CD: Crohn's Disease
  • CRP: C-reactive Protein
  • EHI: Endoscopic Healing Index
  • IBD: Inflammatory Bowel Disease

Disclaimer

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.

Overview

Title

Role of Biomarkers for the Management of Crohn’s Disease

Authoring Organization

Publication Month/Year

November 16, 2023

Last Updated Month/Year

December 4, 2023

Document Type

Guideline

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

Supplemental Methodology Resources

Data Supplement

Methodology

Number of Source Documents
38
Literature Search Start Date
November 21, 2021
Literature Search End Date
September 1, 2022