New guidelines from the American Gastroenterological Association recommend biomarkers found in blood and stools be used in the management of Crohn’s disease, sparing some people with the disease from invasive procedures such as colonoscopies.
The guidelines recommend using the C-reactive protein (CRP) biomarker in blood and the faecal calprotectin (FCP) biomarker in stool to measure inflammation levels and assess whether Crohn’s disease is in remission or active.
“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 the disease,” said Dr Siddarth Singh, a co-author of the guidelines and an associate professor of clinical medicine at the University of California San Diego.
The guidelines recommend biomarkers be used alongside imaging studies and colonoscopies, and at different intervals, depending on the patient, reports Medical News Today.
Under the guidelines, patients in remission would have their biomarkers checked every six to 12 months, while those with active symptoms would have their biomarkers checked every two to four months.
The authors said this was good news for patients, who would not require as many invasive procedures, like colonoscopy.
“Based on this guideline, biomarkers are no longer considered experimental and should be an integral part of inflammatory bowel disease care,” said Dr Ashwin Ananthakrishnan, a co-author of the guidelines and a gastroenterologist at Massachusetts General Hospital.
“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,” he added.
Rates of Crohn’s disease have been on the rise in recent years.
Sufferers can experience symptoms such as abdominal cramping, diarrhoea, and weight loss. The goal of treatment is to keep patients in symptom-free remission, prevent flare-ups, and decrease levels of inflammation in the intestine.
Biomarkers to detect inflammation
The biomarkers suggested in the guidelines are one way of determining levels of inflammation.
“CRP – a simple blood test – is drawn routinely for many different disorders. It’s a general marker for any source of inflammation in the body and is somewhat useful, but definitely flawed. It’s not a perfect biomarker,” Dr Jesse Stondell, a gastroenterologist at UC Davis Health, said.
The other biomarker used in the guidelines is a faecal calprotectin, taken from a stool test.
“It’s much more specific for inflammation in the gastrointestinal tract. If you have an increased faecal calprotectin greater than 150, which is the cut-off for use in the guideline and with which I agree, that indicates there may be significant inflammation in either the colon or the small intestine,” Stondell said.
A shift in approach
Experts said using biomarkers reflects a shift in approach to the management of Crohn’s disease.
“In the past, we were okay with clinical remission. As long as patient symptoms were at the level that we call the clinical remission, that was good enough. Nowadays, we understand that often, when we think the patient is in clinical remission, they are not in deep mucosal remission,” said Dr Ashkan Farhadi a gastroenterologist at MemorialCare Orange Coast Medical Centre.
“When the inflammation is going on, basically the disease is actually going on at a sub-clinical level. The long term consequence is damage to mucosa.”
One of the benefits of using biomarkers is that physicians can change treatments without the need for an invasive colonoscopy.
“It’s allowing us to decide to change therapy in some symptomatic patients without colonoscopy, as we used to do,” Stondell said.
Another benefit is that medications can be adjusted based on levels of inflammation detected.
Dr Saurabh Kapur, a gastroenterologist at the University of Kansas Health System, said he is hopeful the guidelines will result in better outcomes for patients.
“This should standardise management across GI practices, decrease steroid use, and decrease the complications of Crohn’s flares, hospitalisation, and even the need for surgery and bowel resections,” he said.
“So early, effective treatment based on guidelines would lead to better outcomes and decrease the tremendous burden of disease for these patients.”
crohns guidelines
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