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AGA Guideline Makes the Case for Biomarkers in Managing Crohn's Disease

In This Article

  • The American Gastroenterological Association published a clinical practice guideline on the role of biomarkers for the management of Crohn's disease
  • Early treatment for patients with Crohn's disease can substantially offset their risk for long-term disability and the need for future surgical intervention
  • Biomarkers of disease activity might one day provide a less-invasive alternative of tracking treatment response than traditional endoscopies

Successful, early treatment for patients with Crohn's disease (CD) can significantly reduce their risk for long-term disability and surgical intervention. Monitoring the success of CD treatments has traditionally relied on endoscopy procedures. Clinical trials surrounding the potential of serum and fecal biomarkers as a less-invasive means of tracking CD than the traditional endoscopy approach have gained momentum in recent years.

The American Gastroenterological Association (AGA) recently published a clinical practice guideline on the evolving role of biomarkers in managing CD. The AGA publication offers 11 recommendations and represents the work of a multidisciplinary expert panel that conducted a systematic review of the latest studies in CD treatment. Lead author Ashwin N. Ananthakrishnan, MBBS, MPH, director of the Crohn's and Colitis Center at Massachusetts General Hospital and associate professor of Medicine at Harvard Medical School, interviewed with Medscape Medical News to further discuss the AGA guideline's key recommendations for managing CD and the evolving role of biomarkers in these treatments.

He says the current management of inflammatory bowel disease has recognized a treat-to-target strategy. While traditionally assessment has relied on endoscopy, this new guideline emphasizes that fecal and serum biomarkers can be important in assessing the inflammation status in CD patients.

Referring to the timeliness of the AGA guidelines publication, Dr. Ananthakrishnan emphasized that the goal of biomarker research is not to replace the endoscopy approach entirely.

"Studies have looked at biomarkers for the past two decades, but initially, they were experimental," said Dr. Ananthakrishnan. "With a wealth of data now comparing it to the 'gold standard,' which is endoscopic evaluation, we can now robustly say there are several situations where measurement of biomarkers may be sufficient to guide management, and one does not need to perform endoscopic assessment."

According to the guidelines published by the AGA, a normal biomarker can confidently confirm endoscopic remission even in the absence of symptoms. On a case-to-case basis, an elevated biomarker can be used as a decision-making resource in more severe situations with heightened symptoms.

"We envision that gastroenterologists will feel more comfortable routinely using these biomarkers in the management of CD," said Dr. Ananthakrishnan. "There are limited data on biomarkers other than serum C-reactive protein or fecal calprotectin. In the next edition, we may be able to comment on additional biomarkers. We may also be able to comment on serial measurement of biomarkers and how to use them in combination with other tests such as CT, MRI, and intestinal ultrasound."

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Ashwin N. Ananthakrishnan, MBBS, MPH, director of the Crohn's and Colitis Center, helped direct the International Organization for the Study of Inflammatory Bowel Diseases (IBD) in issuing guidance about the role of lifestyle and behavior modification in managing Crohn's disease and ulcerative colitis.


Ashwin N. Ananthakrishnan, MBBS, MPH, and colleagues were part of an American Gastroenterological Association panel that recommended how to use three biomarkers—serum C-reactive protein, fecal calprotectin, and fecal lactoferrin—in place of endoscopic assessment of ulcerative colitis.