The journal Gastroenterology published updated AGA recommendations for the use of biomarkers in the management of patients with Crohn’s disease.
For patients with Crohn’s disease in remission, a symptom- and biomarker-based surveillance strategy is recommended rather than symptom-based surveillance alone. In case of symptomatic remission, determination of biomarker levels every 6-12 months is indicated.
In patients with symptomatic remission and recently confirmed endoscopic remission (without any change in clinical status on stable therapy), it is recommended to use fecal calprotectin levels below 150 mcg/g and C-reactive protein below 5 mg/L to exclude active inflammation and avoid routine use endoscopic evaluation.
In patients with symptomatic remission without recently documented endoscopic remission, endoscopic examination should be used to rule out active inflammation rather than relying solely on fecal calprotectin and C-reactive protein levels.
If inflammatory biomarker levels are elevated in patients in symptomatic remission, endoscopic evaluation rather than initiation of empirical treatment is recommended.
For patients with symptomatically active Crohn’s disease, a strategy that combines biomarker measurement and treatment adjustments rather than relying on disease symptoms alone is recommended. In this case, biomarker levels should be measured every 2–4 months.
In patients with mild symptoms and normal or elevated biomarkers, endoscopic assessment of disease activity is suggested rather than empirical treatment adjustments.
In patients with moderate to severe symptoms, fecal calprotectin levels above 150 mcg/g and C-reactive protein above 5 mg/L are recommended to rule out active inflammation and avoid routine endoscopy. If biomarker levels remain normal, endoscopic assessment of disease activity should be performed.
For asymptomatic patients with surgery-induced remission of Crohn’s disease within a year, a low risk of postoperative recurrence, and one or fewer risk factors for recurrence who are receiving postoperative drug prophylaxis, it is recommended to use fecal calprotectin levels below 50 mcg/g to avoid endoscopic assessment of disease activity. Endoscopic evaluation is indicated for patients at high risk of recurrence and those not receiving drug prophylaxis.