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A new evidence-based guideline for use of blood- and stool-based biomarkers to help manage Crohn’s disease was released today by the American Gastroenterological Association (AGA). Crohn’s is a type of inflammatory bowel disease (IBD), a condition estimated to affect 2.74 million people in the U.S. alone. The guideline was published today in Gastroenterology.

“Based on this guideline, biomarkers are no longer considered experimental and should be an integral part of IBD care,” says author Ashwin Ananthakrishnan, MBBS, MPH, Massachusetts General Hospital.

He added that, “This is a win for Crohn’s disease patients. Biomarkers are usually easier to obtain, less invasive, more cost-effective than frequent colonoscopies and can be assessed more frequently for tighter disease control and better long-term outcomes in Crohn’s disease.”

In IBD, biomarkers such as C-reactive protein (CRP) in blood and fecal calprotectin (FCP) in stool, can measure levels of inflammation. These levels can help doctors assess whether a patient’s Crohn’s disease is active or in remission. AGA recommends the use of biomarkers in addition to colonoscopy and imaging studies.

“Patients’ symptoms do not always match endoscopic findings, so biomarkers are a useful tool to understand and monitor the status of inflammation and guide decision making in patients with Crohn’s disease,” says author Siddarth Singh, MD, MS, University of California, San Diego.

To craft this guideline, a multidisciplinary panel of content experts and guideline methodologists used the Grading of Recommendations Assessment, Development and Evaluation framework to formulate patient-centered clinical questions and review evidence on the performance of FCP, CRP, and Endoscopic Healing Index in patients with established Crohn’s. Biomarker performance was assessed against the gold standard of endoscopic activity, defined as a Simple Endoscopic Score for Crohn’s Disease ≥3.

The recommendations fall into three main buckets:

  1. For patients in remission: Check CRP and FCP every six to 12 months. These tests work best if CRP and FCP levels have previously matched with disease activity seen on endoscopic assessment.

2. For patients experiencing active symptoms: Check CRP and FCP every two to four months for patients experiencing an increase in symptoms (diarrhea and abdominal pain) to guide treatment adjustments. Before making any major treatment plan changes, consider repeating endoscopic or radiologic assessments.

3. WFor patients after surgery, FCP may be useful to monitor those at low risk for disease recurrence.  However, radiologic or endoscopic assessment should be performed when a post-operative recurrence is suspected rather than relying on biomarkers.

Crohn’s can affect any part of the digestive tract, from the mouth to the anus. It causes inflammation and damage to the digestive system, leading to symptoms such as abdominal pain, diarrhea, weight loss, and fatigue and complications such as strictures and fistulas. The incidence peaks in early adulthood and then plateaus at a lower rate. The disease is less commonly diagnosed in Black, Asian, and Hispanic Americans.

It is a lifelong condition with periods of active symptoms (flare-ups) and periods of remission when symptoms are less severe or absent. It can be diagnosed at any age but is most often diagnosed between ages 13 and 30. It can vary in severity and usually requires ongoing medical management to control symptoms and improve quality of life.

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